Decreasing birth asphyxia: utility of statistical process control in a low-resource setting

Area of Science:

• Neonatal care
• Public health
• Improvement science

Background:

• Neonatal mortality is high in low-resource settings, with birth asphyxia being a major contributor.
• Perinatal events, particularly birth asphyxia, disproportionately affect neonatal survival in developing countries.

Purpose of the Study:

• To reduce the incidence of birth asphyxia by 20% at the National Hospital Abuja, Nigeria.
• To implement and evaluate the impact of neonatal resuscitation training and improved equipment availability.

Main Methods:

• A prospective, longitudinal study utilizing statistical process control (SPC) methods.
• Training of labor and delivery staff on Apgar scoring and neonatal resuscitation techniques.
• Monitoring Apgar scores weekly over 25 months using control charts.

Main Results:

• Baseline incidence of low Apgar scores (<7) was 33% (1 min), 17% (5 min), and 10% (10 min).
• Post-intervention, incidence decreased to 18% (1 min), 17% (5 min), and 6% (10 min), representing a 45% and 40% reduction in 1-min and 10-min low Apgar scores, respectively.
• Sustained improvements in neonatal outcomes were observed.

Conclusions:

• Neonatal resuscitation training and enhanced equipment availability are associated with significant reductions in birth asphyxia.
• Improvement science methods are effective for assessing and improving perinatal outcomes in resource-limited environments.
• The study demonstrates the feasibility and utility of these interventions for wider implementation.