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Improving neonatal mortality in an Ethiopian referral hospital
1Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia/Bahir Dar University.
Insights
Implementing basic neonatal care training and protocols significantly reduced Ethiopia
Area of Science:
- Neonatal Medicine
- Public Health
- Pediatrics
Background:
- Ethiopia faces extremely high neonatal mortality rates, necessitating urgent improvements in neonatal care.
- A referral hospital's neonatal unit exhibited a high initial death rate (21%) with significant deficiencies in basic care documentation and monitoring.
Purpose of the Study:
- To enhance neonatal care practices and reduce mortality in a Ethiopian referral hospital's neonatal unit.
- To assess the impact of implementing structured teaching, standardized protocols, and new equipment on neonatal outcomes.
Main Methods:
- Conducted an initial audit of neonatal admissions, focusing on temperature, vital signs, and low birth weight outcomes.
- Initiated regular neonatal care teaching, introduced vital signs charts and unit-specific protocols, trialled Continuous Positive Airway Pressure (CPAP), established Kangaroo Mother Care (KMC), and facilitated staff training and motivation.
- Repeated the audit after six months to evaluate the impact of the interventions.
Main Results:
- The neonatal unit's death rate decreased from 21% to 10% within six months.
- Improved documentation of temperature and vital signs on admission and throughout the stay was observed.
- Outcomes for low birth weight infants improved, with a reduction in deaths or departures against medical advice from 53% to 18%.
Conclusions:
- Regular basic neonatal care teaching, standardized protocols, and the implementation of CPAP and KMC are effective in reducing neonatal mortality.
- The study demonstrates a successful model for improving neonatal care in resource-limited settings.
Abstract:
Ethiopia has one of the world's poorest neonatal mortality rates (1). As a British paediatrician working for one year, the main aim was to improve neonatal care in a referral hospital's neonatal unit. An initial project looking at all admissions to the unit over the month of October 2012, revealed the death rate within the unit was 21% of all admissions. Of the 55 admissions only 43 (75%) had a temperature recorded at admission. 29 (67%) of these were hypothermic, and of these 29 initially hypothermic babies, 19 (65%) remained hypothermic or did not have another temperature documented during their stay. Only 33 (56%) had a heart rate and respiratory rate recorded on admission and only 11 (19%) had any further vital signs recorded during their stay. 19 of the admitted infants had a diagnosis of low birth weight and 10 (53%) of these either died or left against medical advice. With this information regular basic neonatal care teaching sessions for doctors and nursing staff were initiated. Vital signs charts were introduced and unit specific protocols were written. Continuous Positive Airway Pressure (CPAP) was trialled and found to be effective, and CPAP training was given to all nurses and doctors on the unit. A room was set aside to be used solely as Kangaroo Mother Care (KMC). The nurses were taken to a very effective neonatal unit as an 'experience sharing' trip to help with motivation and a grant was also obtained for basic equipment. After 6 months the project was repeated for all the admissions during February 2013. The death rate had progressively fallen and was 10% in February. 54 patients (98%) had a temperature taken on admission and of these, 27 (49%) were hypothermic. 25 (93%) of these hypothermic infants had subsequent temperatures documented which were normal. 54 (98%) had heart rate and respiratory rate recorded on admission and 50 (90%) had them recorded at least daily during their stay. Of the 22 babies with low birth weight (40%), only 4 (18%) died/left against medical advice. 4 received CPAP and 6 were treated with KMC.
