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Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania

BACKGROUND: Every year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health faciliti...

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Autores principales: Makene, Christina Lulu, Plotkin, Marya, Currie, Sheena, Bishanga, Dunstan, Ugwi, Patience, Louis, Henry, Winani, Kiholeth, Nelson, Brett D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247559/
https://www.ncbi.nlm.nih.gov/pubmed/25406496
http://dx.doi.org/10.1186/s12884-014-0381-3
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author Makene, Christina Lulu
Plotkin, Marya
Currie, Sheena
Bishanga, Dunstan
Ugwi, Patience
Louis, Henry
Winani, Kiholeth
Nelson, Brett D
author_facet Makene, Christina Lulu
Plotkin, Marya
Currie, Sheena
Bishanga, Dunstan
Ugwi, Patience
Louis, Henry
Winani, Kiholeth
Nelson, Brett D
author_sort Makene, Christina Lulu
collection PubMed
description BACKGROUND: Every year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities – for example, improving steps to help newborns breathe at birth – have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation. METHODS: Cross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care. RESULTS: Index scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities. CONCLUSIONS: Within two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania.
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spelling pubmed-42475592014-11-30 Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania Makene, Christina Lulu Plotkin, Marya Currie, Sheena Bishanga, Dunstan Ugwi, Patience Louis, Henry Winani, Kiholeth Nelson, Brett D BMC Pregnancy Childbirth Research Article BACKGROUND: Every year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities – for example, improving steps to help newborns breathe at birth – have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation. METHODS: Cross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care. RESULTS: Index scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities. CONCLUSIONS: Within two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania. BioMed Central 2014-11-19 /pmc/articles/PMC4247559/ /pubmed/25406496 http://dx.doi.org/10.1186/s12884-014-0381-3 Text en © Makene et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Makene, Christina Lulu
Plotkin, Marya
Currie, Sheena
Bishanga, Dunstan
Ugwi, Patience
Louis, Henry
Winani, Kiholeth
Nelson, Brett D
Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania
title Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania
title_full Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania
title_fullStr Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania
title_full_unstemmed Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania
title_short Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania
title_sort improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247559/
https://www.ncbi.nlm.nih.gov/pubmed/25406496
http://dx.doi.org/10.1186/s12884-014-0381-3
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