A health partnership to reduce neonatal mortality in four hospitals in Rwanda

Abstract

BackgroundA health partnership to improve hospital based neonatal care in Rwanda to reduce neonatal mortality was requested by the Rwandan Ministry of Health. Although many health system improvements have been made, there is a severe shortage of health professionals with neonatal training.MethodsFollowing a needs assessment, a health partnership grant for 2 years was obtained. A team of volunteer neonatologists and paediatricians, neonatal nurses, lactation consultants and technicians with experience in Rwanda or low-income countries was assembled.A neonatal training program was provided in four hospitals (the 2 University hospitals and 2 district hospitals), which focused on nutrition, provision of basic respiratory support with nasal CPAP (Continuous Positive Airway Pressure), enhanced record keeping, thermoregulation, vital signs monitoring and infection control. To identify if care delivery improved, audits of nutritional support, CPAP use and its complications, and documentation in newly developed neonatal medical records were conducted. Mortality data of neonatal admissions was obtained.ResultsIntensive neonatal training was provided on 27 short-term visits by 10 specialist health professionals. In addition, a paediatric doctor spent 3 months and two spent 6 months each providing training. A total of 472 training days was conducted in the neonatal units.For nutritional support, significant improvements were demonstrated in reduction in time to initiation of enteral feeds and to achieve full milk feeds, in reduction in maximum postnatal weight loss, but not in days for regaining birth weight. Respiratory support with bubble CPAP was applied to 365 infants in the first 18 months. There were no significant technical problems, but tissue damage, usually transient, to the nose and face was recorded in 13%. New medical records improved documentation by doctors, but nursing staff were reluctant to use them. Mortality for University teaching hospital admissions was reduced from 23.6% in the 18 months before the project to 21.7%. For the two district hospitals, mortality reduced from 10% to 8.1%. A major barrier to training and improved care was low number of nurses working on neonatal units and staff turnover.ConclusionThis health partnership delivered an intensive program of capacity building by volunteer specialists. Improved care and documentation were demonstrated. CPAP was successfully introduced. Mortality was reduced. This format can be adapted for further training and improvement programs to improve the quality of facility-based care.

Mortality, morbidity and clinical care in a referral neonatal intensive care unit in Haiti

“…In order to target limited resources toward improving outcomes, we performed a chart review of a national referral NICU in Haiti to ascertain areas for targeted interventions. Similar chart reviews in other low and mid income countries (LMICs), such as Uganda [12] have been performed and have shown that evaluation of current practices may lead to decreased mortality in low resource settings such as in Rwanda [13]. The differences in characteristics observed between the neonates who died in the NICU and those that survived to discharge suggest specific patterns of neonatal morbidity and mortality.…”

Immediate and Sustained Effect of Neonatal Teaching in a Perinatal Setting in Urban Laos

“…Although there is evidence for persistently high mortality despite training in certain developing countries, 7 it is shown in university hospitals as well as district hospitals in Rwanda that mortality can be reduced by providing intensive neonatal training. 8 Significant improvements in knowledge have been shown for team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico. 9 This corresponds to the intention of our combined obstetric and pediatric teaching setting, although this may be difficult to quantify.…”

Competencies for structured professional development of neonatal nurses in South Africa

“…During phase 2, a literature review was conducted on existing neonatal competency frameworks, and those included were the Royal College of Nursing (UK), [7] Rwandan Competency Framework, [8] Scottish Neonatal Nurses' Group, [9] Australian College of Neonatal Nurses [10] and the Pan-London Band 5 Competency Document. [11] Through a process of inductive and deductive reasoning, the competencies were formulated as an abridged list of competencies and verified by seven neonatal nursing experts through the Delphi technique.…”

“…[6] Several neonatal competency frameworks have been developed over time. [7][8][9][10][11] In developed countries, neonatal competencies seem to have comparable domains such as using research and evidence, leadership and professional development, communication, and legal and ethical considerations. [7,[9][10][11] None of these could be applied directly to the SA context, since neonatal care takes place in a variety of settings.…”