Evaluating a Multi-Site Quality Improvement Intervention for Early Essential Newborn Care: Trends and Persistent Gaps...

Early Essential Newborn Care (EENC) is an evidence-based strategy to reduce neonatal morbidity and mortality, yet implementation gaps persist in many low- and middle-income countries. In Vietnam, a multi-site quality improvement initiative, including clinical training, on-site coaching, supportive supervision, and facility-level quality improvement planning, was implemented to strengthen EENC practices across diverse hospital settings.

A repeated cross-sectional study was conducted in 14 hospitals across four provinces using data from three assessment rounds (December 2022, March 2024, and August 2024). Targeted EENC quality improvement activities were implemented between Rounds 1 and 2 and reinforced between Rounds 2 and 3. Medical record reviews, maternal interviews, and facility assessments were used to evaluate changes in EENC implementation. Indicators were selected based on WHO EENC standards, clinical and programmatic relevance, alignment with the intervention package, and availability across all three rounds. Proportions were compared using chi-square or Fisher's exact tests, as appropriate.

Improvements were observed in several technical practices. Immediate skin-to-skin contact increased from 32.5% in Round 1 to 73.8% in Round 3, and sustained skin-to-skin contact from 8.2% to 38.4% (p<0.001). Vitamin K1 administration rose from 93.0% to 99.3%, and non-application of antibiotic eye ointment from 88.8% to 98.8% (p<0.001). However, several indicators declined, including non-separation of mother and newborn (96.8% to 81.0%), early breastfeeding initiation (83.1% to 73.5%), no prelacteal feeding (28.0% to 19.1%), uterotonic use (99.3% to 94.6%), and uterine contraction monitoring (98.9% to 90.2%) (all p≤0.03). In Round 3, cesarean births showed persistent gaps compared with vaginal births.

The quality improvement initiative was associated with gains in selected technical EENC practices. However, declines in maternal monitoring and mother-infant support practices, and persistent gaps after cesarean birth, indicate that training and supervision alone are insufficient. Broader health-system strengthening is required to sustain full EENC implementation.