A retrospective study of neonatal case management and outcomes in rural Rwanda post implementation of a national neonatal care package for sick and small infants

Abstract

BackgroundDespite worldwide efforts to reduce neonatal mortality, 44% of under-five deaths occur in the first 28 days of life. The primary causes of neonatal death are preventable or treatable. This study describes the presentation, management and outcomes of hospitalized newborns admitted to the neonatal units of two rural district hospitals in Rwanda after the 2012 launch of a national neonatal protocol and standards.MethodsWe retrospectively reviewed routinely collected data for all neonates (0 to 28 days) admitted to the neonatal units at Rwinkwavu and Kirehe District Hospitals from January 1, 2013 to December 31, 2014. Data on demographic and clinical characteristics, clinical management, and outcomes were analyzed using median and interquartile ranges for continuous data and frequencies and proportions for categorical data. Clinical management and outcome variables were stratified by birth weight and differences between low birth weight (LBW) and normal birth weight (NBW) neonates were assessed using Fisher’s exact or Wilcoxon rank-sum tests at the α = 0.05 significance level.ResultsA total of 1723 neonates were hospitalized over the two-year study period; 88.7% were admitted within the first 48 h of life, 58.4% were male, 53.8% had normal birth weight and 36.4% were born premature. Prematurity (27.8%), neonatal infection (23.6%) and asphyxia (20.2%) were the top three primary diagnoses. Per national protocol, vital signs were assessed every 3 h within the first 48 h for 82.6% of neonates (n = 965/1168) and 93.4% (n = 312/334) of neonates with infection received antibiotics. The overall mortality rate was 13.3% (n = 185/1386) and preterm/LBW infants had similar mortality rate to NBW infants (14.7 and 12.2% respectively, p = 0.131). The average length of stay in the neonatal unit was 5 days.ConclusionsOur results suggest that it is possible to provide specialized neonatal care for both LBW and NBW high-risk neonates in resource-limited settings. Despite implementation challenges, with the introduction of the neonatal care package and defined clinical standards these most vulnerable patients showed survival rates comparable to or higher than neighboring countries.

Prevalence of perinatal asphyxia in East and Central Africa: systematic review and meta-analysis

“…From the rest 94 articles, 48 were excluded as a result of not fulfilling our inclusion criteria by reviewing their titles and abstracts. Therefore, 46 full-text articles were accessed and assessed for eligibility based on the inclusion criteria [3,15,17,20,21,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71]. Finally, 13 studies that fulfilled the eligibility criteria were included in the meta-analysis (Figure 1).…”

Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24–47 months in rural Rwanda

“…In Rwanda, 10% of newborns are born preterm each year and 7% are born with LBW [ 33 ]. Prematurity/LBW and HIE are two of the three leading causes of admission to hospital neonatal care units in Rwanda [ 34 ]. However, to our knowledge, mental health among mothers of children with these perinatal risk factors has not been studied in Rwanda.…”

Essential Newborn Care Among Postnatal Mothers at Selected Health Centers in Eastern Province, Rwanda

“…A recent study conducted in Ethiopia found that 60.2% of mothers had poor ENC knowledge. [5] Authors of a study in Bangladesh found that mothers were knowledgeable about breastfeeding and thermoregulation, yet identified a gap in cord care. [6] Countries that have shown reductions in newborn deaths, infections, and intensive care unit admissions using ENC has encouraged others to follow the WHO evidencebased guidelines.…”