Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania

Abstract

BackgroundEvery year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities – for example, improving steps to help newborns breathe at birth – have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation.MethodsCross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care.ResultsIndex scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities.ConclusionsWithin two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania.

The power of practice: simulation training improving the quality of neonatal resuscitation skills in Bihar, India

“…This is consistent with previously published studies [12, 14]. In interviews, mentors suggested that knowledge of EBPs increased with training.…”

Knowledge of Health Professionals on Essential Newborn Care in Bamako, Mali

“…Essential newborn care combines all gestures (resuscitation, hypothermia prevention, cord care, eye care, vitamin K1 administration, early initiation of breastfeeding and instructions for the first bath) were given to a newborn at birth to optimize his/her chance for survival [5] [6]. In Tanzania, an evaluation had revealed poor health professionals on ENC [7]. It led to massive training that resulted in a 47% reduction in neonatal mortality [7].…”

“…In Tanzania, an evaluation had revealed poor health professionals on ENC [7]. It led to massive training that resulted in a 47% reduction in neonatal mortality [7].…”

“…Despite this, Brantuo MN[29] has shown in Ghana that it is the retraining interventions that improve the level of knowledge and skills. Regardless of the initial training, studies agree on the positive impact of specific training on essential newborn care on the level of knowledge of the health professionals[7]…”

Progress towards Millennium Development Goals 4 & 5: strengthening human resources for maternal, newborn and child health

“…Quality improvement approaches have been widely used with some success, such as in Tanzania, where performance in newborn care improved, but newborn resuscitation performance remained unchanged [31]. …”