Impact analysis and evaluation of the Ethiopian Neonatal Network

The Ethiopian Neonatal Network (ENN) represents one of the first low-income country neonatal quality improvement (QI) communities. To determine if changes in structure, process and outcome measures were associated with formation of the ENN and to learn from teams, quantitative and qualitative analyses were completed. All infants discharged during 2018-2022 from 11 hospitals with consistent data collection over the 5-year period were included in infant-level analyses. Trends by year were evaluated using Cochran-Armitage tests. Annual surveys captured facility-level data. Nurse and physician leads at ENN hospitals participated in focus groups in 2023. Inductive and deductive approaches were used to extract themes and findings. Overall, 38 049 infants were discharged. Participating sites reduced nurse-to-patient ratios, increased newborn beds and implemented continuous positive airway pressure (CPAP) with blended oxygen. There were significant increases in antenatal steroid exposure, kangaroo mother care and receipt of oxygen or CPAP among infants with respiratory distress (p<0.0001). Admission hypothermia among inborn infants decreased (p<0.0001). Overall survival decreased (p<0.0001). Mortality due to prematurity-related complications decreased (p=0.0089) while mortality due to infection increased (p=0.0016). Three themes were determined from focus groups: positive changes to data utilisation and patient care following ENN membership, data entry, technical issues and buy-in as barriers to participation and recommendations on additional support. Development of the ENN was associated with adopting a culture of data-driven improvement, positive changes in measurable quality of care and improved patient outcomes. Sustaining, spreading and evaluating multidisciplinary neonatal QI communities are important components to global efforts targeting mortality reduction.