Impact of Quality Improvement Bundle on Neonatal Mortality in a District Hospital in Tanzania

The poor quality of care received by mothers and neonates in many limited-resource countries represents a main determinant of newborn mortality. Small and sick hospitalized newborns are the highest-risk population, and they should be one of the prime beneficiaries of quality-of-care interventions. This study aimed to evaluate the impact on neonatal mortality of quality improvement interventions which were implemented at Tosamaganga Council Designated Hospital, Iringa, Tanzania, between 2016 and 2020.

A retrospective comparison between pre- and post-intervention periods was performed using the chi-square test and Fisher's exact test. Effect sizes were reported as odds ratios with 95% confidence intervals.

The analysis included 5742 neonates admitted to the Special Care Unit (2952 in the pre-intervention period and 2790 in the post-intervention period). A decrease in mortality among infants with birth weight between 1500 and 2499 g (overall: odds ratio 0.49, 95% confidence interval 0.27-0.87; inborn: odds ratio 0.50, 95% confidence interval 0.27-0.93) was found. The analysis of cause-specific mortality showed a decrease in mortality for asphyxia (odds ratio 0.33, 95% confidence interval 0.12-0.87) among inborn infants with birth weight between 1500 and 2499 g.

A quality improvement intervention was associated with decreased mortality among infants with birth weight between 1500 and 2499 g. Further efforts are needed to improve prognosis in very-low-birth-weight infants.