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Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment.

ABSTRACT: BACKGROUND:Preterm birth is a worldwide challenge with the highest burden in low- and middle-income countries. Despite availability of low-cost interventions to decrease mortality of preterm, low birth weight, and sick newborns, these interventions are not well integrated in the health systems of low- and middle-income countries. The aim of this study was to assess, from the perspective of key stakeholders comprising leaders in the public health system, the health system readiness to support health care facilities in the care provided to preterm, low birth weight, and sick newborns in different regions of Ethiopia. METHODS:A qualitative assessment using in-depth interviews with health facility leaders was conducted in health facilities in 3 regions of Ethiopia from December 2017 to February 2018. The interview guide was developed using a modified version of the World Health Organization health system building blocks. RESULTS:Across the public health system, adequate and reliable space, power, and water were problematic. Human resource issues (training, staffing, and retention) were critical to being able to properly care for preterm, low birth weight, and sick newborns. Problems with functional equipment and equipment distribution systems were widespread. Funds were lacking to support preterm, low birth weight, and sick newborn needs in facilities. Data collection practices, data quality, and data utilization were all problematic. There were gaps in the availability of guidelines and protocols, specifically targeting preterm, low birth weight, and sick newborn care. Key facilitators, information disseminators, and influencers identified in the study were the Health Development Army, community and religious leaders, and mothers and families who had had positive experiences or outcomes of care. CONCLUSIONS:The Ethiopian health system has opportunities across all 7 World Health Organization health system building blocks to strengthen readiness to support health facilities to provide quality care and improve outcomes for preterm, low birth weight, and sick newborns.

SUBMITTER: Usman AK

PROVIDER: S-EPMC6868682 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment.

Usman Abubeker Kedir AK Wolka Eskinder E Tadesse Yared Y Tariku Abraham A Yeshidinber Abate A Teklu Alula M AM Senturia Kirsten K Gezahegn Wendemaghen W Litch James A JA

BMC health services research 20191121 1

<h4>Background</h4>Preterm birth is a worldwide challenge with the highest burden in low- and middle-income countries. Despite availability of low-cost interventions to decrease mortality of preterm, low birth weight, and sick newborns, these interventions are not well integrated in the health systems of low- and middle-income countries. The aim of this study was to assess, from the perspective of key stakeholders comprising leaders in the public health system, the health system readiness to sup ...[more]

PMID: 31752863

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Project description:BackgroundBirth asphyxia accounted for nearly 50% of neonatal mortality in Sub-Saharan African countries. This scenario has been worst in Ethiopia where every two out of three deaths attributed to birth asphyxia. Moreover, studies conducted in Ethiopia were highly variable and inconclusive to estimate the pooled prevalence and determinants of perinatal birth asphyxia among preterm babies.ObjectiveThis study aimed to estimate the pooled prevalence of birth asphyxia and its determinants among preterm newborns in Ethiopia.MethodsThe protocol for this review is registered at PROSPERO with registration number CRD42020158224. A comprehensive online databases (PubMed, HINARI, Scopus, EMBASE, Science direct, and Cochrane library database), Google Scholar, African Journals online, other gray and online repository accessed studies will be searched using different search engines. In addition, maternity and infant care databases uploaded at Ethiopian Health Development Journal and Ethiopian Journal of Health Sciences will be searched until 30 June 2020. Newcastle-Ottawa Quality Assessment Scale (NOS) will be used for critical appraisal of studies. Three reviewers will screen all retrieved articles, conduct data extraction, and then critically appraise all identified studies. All identified observational studies reporting the prevalence of birth asphyxia and associated factors among neonates in Ethiopia will be considered. The analysis of data will be done using STATA 11.0. We will demonstrate pooled estimates and determinants of birth asphyxia with effect size and 95% confidence interval. Heterogeneity among the included studies will be assessed through the Cochrane Q test statistics and I2 test. Publication bias will be checked using funnel plot and Egger's test. Finally, statistical significance level will be declared at a p value of less than 0.05.DiscussionThe result from this systematic review will inform and guide health policy planners to invest limited resources on maternal and neonatal health. Furthermore, it will be a stimulus for future cumulative meta-analysis researchers in developing nations.

Project description:Background:The successful promotion of facility births in low and middle-income countries has not always resulted in improved neonatal outcome. We evaluated key signal functions pertinent to Level II neonatal care to determine facility readiness to care for high risk/ small and sick newborns. Method:Facility readiness for care of high risk/ small and sick babies was determined through self-evaluation using a pre-designed checklist to determine key signal functions pertinent to Level II neonatal care in selected referral hospitals in Uganda (10), Indonesia (4) and India (2) with focus on the Sub-Saharan country with greater challenges. Results:Most facilities reported having continuous water supply, resources for hand hygiene and waste disposal. Delivery rooms had newborn corners for basic neonatal resuscitation, but few practiced proper reprocessing of resuscitation equipment. Birth weight records were not consistently maintained in the Ugandan hospitals. In facilities with records of birth weights, more than half (51.7%) of newborns admitted to the neonatal units weighed 2500?g or more. Neonatal mortality rates ranged from 1.5 to 22.5%. Evaluation of stillbirths and numbers of babies discharged against medical advice gave a more comprehensive idea of outcome. Kangaroo Mother Care was practiced to varying extents. Incubators were more common in Africa while radiant warmers were preferred in Indian hospitals. Tube feeding was practiced in all and cup feeding in most, with use of human milk at all sites. There were proportionately more certified pediatricians and nurses in Indonesia and India. There was considerable shortage of nursing staff, (worst nurse -bed ratio ranging from 1 to 15 in the day shift, and 1 to 30 at night). There was significant variability in facility readiness, as in data maintenance, availability of commodities such as linen, air -oxygen blenders and infusion pumps and of infection prevention practices. Conclusions:Referral neonatal units in LMIC have challenges in meeting even the basic level II requirements, with significant variability in equipment, staffing and selected care practices. Facility readiness has to improve in concert with increased facility births of high risk newborns in order to have an impact on neonatal outcome, and on achieving Sustainable Development Goals 3.2.2.

Project description:BackgroundEach year an estimated 2.6 million newborns die, mainly from complications of prematurity, neonatal infections, and intrapartum events. Reducing these deaths requires high coverage of good quality care at birth, and inpatient care for small and sick newborns. In low- and middle-income countries, standardised measurement of the readiness of facilities to provide emergency obstetric care has improved tracking of readiness to provide care at birth in recent years. However, the focus has been mainly on obstetric care; service readiness for providing inpatient care of small and sick newborns is still not consistently measured or tracked.MethodsWe reviewed existing international guidelines and resources to create a matrix of the structural characteristics (infrastructure, equipment, drugs, providers and guidelines) for service readiness to deliver a package of inpatient care interventions for small and sick newborns. To identify gaps in existing measurement systems, we reviewed three multi-country health facility survey tools (the Service Availability and Readiness Assessment, the Service Provision Assessment and the Emergency Obstetric and Newborn Care Assessment) against our service readiness matrix.FindingsFor service readiness to provide inpatient care for small and sick newborns, our matrix detailed over 600 structural characteristics. Our review of the SPA, the SARA and the EmONC assessment tools identified several measurement omissions to capture information on key intervention areas, such as thermoregulation, feeding and respiratory support, treatment of specific complications (seizures, jaundice), and screening and follow up services, as well as specialised staff and service infrastructure.ConclusionsOur review delineates the required inputs to ensure readiness to provide inpatient care for small and sick newborns. Based on these findings, we detail where questions need to be added to existing tools and describe how measurement systems can be adapted to reflect small and sick newborns interventions. Such work can inform investments in health systems to end preventable newborn death and disability as part of the Every Newborn Action Plan.

Project description:BackgroundGlobally, every year greater than twenty million newborns are born weighing less than 2500grams, of which over 96% of them were in developing countries. It contributes to sixty to eighty percent of all neonatal deaths, annually. These infants weighing less than 2500gram will have a poor immune system and are at risk of morbidity and mortality. This study was aimed to investigate the survival status and predictors of mortality among neonates admitted with low birth weight at public hospitals in Ethiopia.MethodA prospective cohort study was conducted among selected 216 newborns admitted with low birth weight who were admitted in neonatal intensive care unit at Arba Minch General hospital, Sawla General Hospital and Chencha district hospital from 1st March 2018 to 28st February 2019. Data were entered into Epi data version 3.02 and exported to STATA V 14 for analysis. The Kaplan Meier survival curve together with log rank test was used to estimate the survival time of the newborns. Variables which had p-value <0.05 in multivariable analysis using the cox proportional hazard model were declared as statistically significant.ResultThe cumulative proportion of surviving at the end of third days was 99.01% (95%CI: 96.11, 99.75). Similarly it was 97.81% (95%CI: 94.25, 99.18), 96.27% (95%CI: 91.76, 98.33) and 94.33% (95%CI: 88.72, 97.19) at the end of fourth, fifth and sixth day respectively. The overall mean survival time was 17.13 days (95%CI: 12.76, 21.49). The incidence of mortality among neonates admitted with low birth weight was 83 per 1000 live births. Mothers with DM (AHR:4.79; 95%CI:1.15, 19.8), maternal HIV infection(AHR:6.47;95%CI:1.43,29.3), not keeping the newborn under KMC(AHR:13.0;95%CI:3.42, 49.5) and initiating exclusive breast feeding within one hour(AHR:0.19;95%CI:0.04, 0.95) were statistically significant in multivariable cox regression analysis.ConclusionThe risk of mortality among neonates admitted with low birth weight was high at the early admission period and the incidence of mortality was high. Maternal history of diabetes mellitus, HIV/AIDS infection, keeping the newborn under kangaroo mother care and exclusive breast feeding initiation were statistically significant predictors of mortality. Special emphasis should be given for neonates with low birth weight at the early follow up periods and Kangaroo mother care practice should be a usual practice.

Project description:BackgroundThe high proportion of birth weight in Ethiopia is hypothesized to be due to inadequate maternal diet which is associated with poor nutrition education during pregnancy. There was no study that evaluated the effect of nutrition education on birth weight in the study area. This study aimed to assess the effects (overall, direct and indirect effects) of guided counseling on the birth weight of neonates.MethodsA two-arm parallel cluster randomized controlled community trial was conducted from May 1, 2018, to April 30, 2019, in West Gojjam Zone, Northwest Ethiopia. At the baseline, 346 pregnant women in the 11 intervention clusters and 348 pregnant women in the 11 control clusters were recruited. However, birth weight was measured from 258 and 272 newborns in the intervention and control groups, respectively. In the intervention group, counseling was given monthly for four consecutive months in the participant's homes. Besides, leaflets with key counseling messages were distributed to each woman in the intervention arm. Pregnant women who attended routine nutrition education given by the health system were recruited as control. Dietary practice, nutritional status, and birth weight were the primary, secondary and tertiary outcomes of this intervention. Data were collected using a structured data collection tool. Birth weight was measured within 48 h after birth. Independent sample t-test, linear mixed-effects model, and path analysis were fitted to assess effects of the intervention.ResultsThe intra-cluster correlation coefficient was 0.095. The average birth weight of newborns in the intervention group was 0.257 kg higher compared with their counterparts in the control arm (β = 0.257, P < 0.001). The direct effect of this intervention on birth weight was 0.17 (β = 0.17, P<0.001 ) whereas the indirect effect of this intervention was 0.08 (β = 0.08, P<0.001 ).ConclusionCounseling using the health belief model and the theory of planned behavior has a positive effect on improving birth weight. The findings suggest the need for enhancing nutrition education of pregnant women through the application of theories to improve birth weight.Trial registrationClinical Trials.gov NCT03627156 , "Retrospectively registered Jun, 13, 2018".

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Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment.

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Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment.

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