Introduction: Understanding the extent and cause of high neonatal deaths rates in Sub-Saharan Africa is a challenge, especially in the presence of poor-quality and inaccurate data. The NeoTree digital data capture and quality improvement system has been live at Kamuzu Central Hospital, Neonatal Unit, Malawi, since April 2019.Objective: To describe patterns of admissions and outcomes in babies admitted to a Malawian neonatal unit over a 1-year period via a prototype data dashboard.Methods: Data were collected prospectively at the point of care, using the NeoTree app, which includes digital admission and outcome forms containing embedded clinical decision and management support and education in newborn care according to evidence-based guidelines. Data were exported and visualised using Microsoft Power BI. Descriptive and inferential analysis statistics were executed using R.Results: Data collected via NeoTree were 100% for all mandatory fields and, on average, 96% complete across all fields. Coverage of admissions, discharges, and deaths was 97, 99, and 91%, respectively, when compared with the ward logbook. A total of 2,732 neonates were admitted and 2,413 (88.3%) had an electronic outcome recorded: 1,899 (78.7%) were discharged alive, 12 (0.5%) were referred to another hospital, 10 (0.4%) absconded, and 492 (20%) babies died. The overall case fatality rate (CFR) was 204/1,000 admissions. Babies who were premature, low birth weight, out born, or hypothermic on admission, and had significantly higher CFR. Lead causes of death were prematurity with respiratory distress (n = 252, 51%), neonatal sepsis (n = 116, 23%), and neonatal encephalopathy (n = 80, 16%). The most common perceived modifiable factors in death were inadequate monitoring of vital signs and suboptimal management of sepsis. Two hundred and two (8.1%) neonates were HIV exposed, of whom a third [59 (29.2%)] did not receive prophylactic nevirapine, hence vulnerable to vertical infection.Conclusion: A digital data capture and quality improvement system was successfully deployed in a low resource neonatal unit with high (1 in 5) mortality rates providing and visualising reliable, timely, and complete data describing patterns, risk factors, and modifiable causes of newborn mortality. Key targets for quality improvement were identified. Future research will explore the impact of the NeoTree on quality of care and newborn survival.
BackgroundCritical care specialty deals with the complex needs of critically ill patients. Nurses who provide critical care are expected to possess the appropriate knowledge and skills required for the care of critically ill patients. The aim of this study was to assess the effect of an educational programme on the competence of critical care nurses at two tertiary hospitals in Lilongwe and Blantyre, Malawi.MethodsA quantitative pre- and post-test design was applied. The training programme was delivered to nurses (n = 41) who worked in intensive care and adult high dependency units at two tertiary hospitals. The effect of the training was assessed through participants’ self-assessment of competence on the Intensive and Critical Care Nursing Competence Scale and a list of 10 additional competencies before and after the training.ResultsThe participants’ scores on the Intensive and Critical Care Nursing Competence Scale before the training, M = 608.2, SD = 59.6 increased significantly after the training, M = 684.7, SD = 29.7, p <.0001 (two-tailed). Similarly, there was a significant increase in the participants’ scores on the additional competencies after the training, p <.0001 (two-tailed). ConclusionThe programme could be used for upskilling nurses in critical care settings in Malawi and other developing countries with a similar context.
ObjectiveTo explore doctors’ experiences of referring and admitting patients to the intensive care unit (ICU) at two tertiary hospitals in Malawi.DesignThis was a qualitative study that used face-to-face interviews. The interviews were audiotaped and transcribed verbatim into English. The data were analysed manually through conventional content analysis.SettingTwo public tertiary hospitals in the central and southern regions of Malawi. Interviews were conducted from January to June 2021.ParticipantsSixteen doctors who were involved in the referral and admission of patients to the ICU.ResultsFour themes were identified namely, lack of clear admission criteria, ICU admission requires a complex chain of consultations, shortage of ICU resources, and lack of an ethical and legal framework for discontinuing treatment of critically ill patients who were too sick to benefit from ICU.ConclusionDespite the acute disease burden and increased demand for ICU care, the two hospitals lack clear processes for referring and admitting patients to the ICU. Given the limited bed space in ICUs, hospitals in low-income countries, including Malawi, need to improve or develop admission criteria, severity scoring systems, ongoing professional development activities, and legislation for discontinuing intensive care treatments and end-of-life care.
IntroductionThe coronavirus pandemic overwhelmed the healthcare landscape, placing a strain on healthcare workers worldwide. In addition todirectly causing the deaths of people, the COVID-19 pandemic disrupted critical health services in developing countries. The studyaimed to explore the experiences of healthcare workers who cared for critically ill COVID-19 patients at a tertiary hospital in Malawi.MethodsA qualitative descriptive design was used. Data were gathered through in-depth interviews with doctors, clinical officers, nurses, andallied staff (n=25) who were involved in the care of critically ill COVID-19 patients at the hospital’s COVID-19 treatment centres duringthe first and second waves of the pandemic in Malawi. The interviews were conducted in English, audiotaped, and later transcribedverbatim. Conventional content analysis was used to analyse the data following the steps proposed by Hsieh and Shannon1.ResultsThe overall experience of the health workers was negative. However, delivering care to critically ill COVID-19 patients was associatedwith positive and negative experiences. The positive experience was a result of teamwork among staff and support from hospital authoritiesand the community. Negative experiences, on the other hand, were attributed to a lack of knowledge and skills in managing critically illCOVID-19 patients, a lack of resources, and abuse by some patients and members of the community. Furthermore, there was fear ofcontracting the virus from patients and fellow health workers while providing care.ConclusionThe findings point to the need for adequate preparedness within the health sector to support and protect the healthcare workers andindividuals they look after. There is a need for disease awareness strategies for health workers and the general public for future pandemics.
Background: The birth of a premature infant and admission to the NICU is often unexpected and traumatic for families, leading to increased distress and can negatively impact parental-infant attachment. Appropriate interventions can help to lessen the negative impact of a NICU admission on families, improving parental mental health, reducing distress, enhancing parent- infant relationships, and improving the long-term physical, cognitive, emotional, and social development of the infant. Aims: The purpose of this study is to examine and evaluate research evidence on the effectiveness of current interventions for improving parental distress in the NICU. Methods: A rapid review was conducted utilizing a protocol based on the Virginia Commonwealth University guidance. Keyword searches were conducted on CINAHL, MEDLINE, and PsychINFO, and studies were selected according to pre-defined eligibility criteria, published between January 2015 and January 2020. The literature search included primary studies of interventions with parental stress and/or anxiety reduction as outcomes. Results: A total of 14 articles were included, evaluating the effectiveness of 13 different interventions, including narrative writing, art therapy, structured nursing interventions, anxiety counselling, spiritual care, organizational change, music therapy, relaxation, and mindfulness techniques. With the Pexception of three, all the studies found significant results in the reduction of stress and/or anxiety levels of the subjects, with mothers having overall higher levels of stress indicated by higher stress scores on standardized measurement tools. Conclusion: There is a need for ongoing assessment of parental distress and integration of appropriate interventions within the NICU settings. In this review, both individualized and group interventions including narrative writing, art therapy, music therapy, spiritual care, activity-based group therapy, music therapy, audio-assisted relaxation techniques, mindfulness based neurodevelopmental care, cognitive behavioral based counselling, family nurture intervention and a structured nursing intervention were shown to be effective in reducing parental stress and/or anxiety in the NICU. The small scale of the studies included in this review impact generalizability to a broader audience and emphasizes the need for larger scope, multi-center studies at an international level to build on and broaden our level of knowledge on how to better support families and reduce parental distress in the NICU.
moments like nursing handovers and ward rounds were noted to be the loudest periods, with a range of 65 to 70 dB.The questionnaires reflect that although staff members have some knowledge on noise levels and their impact on the newborn, education on the effect of noise in ambience around preterm can be helpful.On the subject of the permissible loudness, 53.3% of staff answered 55dB, most of the participants were unsure. Regarding the level of noise at which babies start experiencing pain, 60% answered more than 90dB, and 13.3% answered more than 200dB. Handovers and conversations in the unit were noted to have a physiological and psychological effect on the neonates as evidenced by previous studies and suggestions were made to reduce the noise by altering alarm volumes, adding visual aids, and educating staff and parents Conclusions We conclude that the loudness of noise has adverse effects on the quality of care of newborns. Guidelines to regulate the noise intensity should be followed to ensure the best of care to growing preterms. Moving forward, our intended actions would be: to educate staff and parents on this topic, obtain a certified device to monitor the noise level, alter the environmental factors influencing the increase in noise and use visual aids to help reduce the noise in our unit thus protecting the newborn babies from harmful noise exposure.
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