Gaps in neonatal thermal care in low-resource settings: A web-based survey of healthcare workers.

Abstract

Background: Hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. Despite the recognition of the importance of thermal care for neonates a century ago and the established WHO guidelines, a high prevalence of neonatal hypothermia is still regularly reported. Hypothermia is avoidable in the majority of neonates because it is not a complication of prematurity but more the result of inadequate thermal care. The objective of this study was to explore the current gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings.Methods: We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results: Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the hand or foot temperature by hand-touch. The usefulness of the axillary or rectal temperature was valued higher than that of the hand or foot temperature as an indicator of cold stress. Opinions diverged regarding the hand or foot temperature, including apparent inaccuracy compared to axillary or rectal temperature. Preferences on rewarming strategies widely differed among participants and so did the availability of warming equipment in their institutions. Conclusions: We identified the general acknowledgment of the importance of the WHO warm chain but also its limited practice. We also identified that an inadequate understanding of cold stress underestimates the potential benefits of the hand or foot temperature and leads to missed opportunities for timely prevention of hypothermia. Furthermore, lack of consistent guidance on equipment for rewarming hypothermic neonates hampers recovery.

Establishment of a neonatal nursery in a rural district hospital in Malawi: A retrospective review of neonatal outcomes in Neno District Hospital (2014 - 2021)

“…This was likely due to earlier recognition, clinical diagnosis and better treatment with the establishment of the nursery. Recent studies in similar contexts with neonatal nurseries have suggested that multidisciplinary approaches such as antibiotic stewardship, hygiene and protocols for feeding are necessary to further reduce the burden of sepsis in preterm infants [47,48,49], which can be extrapolated to full-term infant sepsis prevention. Future interventions might include improved diagnostics, empiric antibiotic treatment when sepsis is clinically suspected, and improved patient observation [49][50].…”

“…One limitation in Neno District is the lack of rst-trimester antenatal ultrasound dating with the need for postnatal determination of neonates who are preterm versus low birth weight. If postnatal dating of neonates is not completed, especially within 24 hours of admission, using birth weight or maternal or health care worker reports of the number of months pregnant mentorship, standardized protocols, and essential equipment and medicine availability, as demonstrated in other studies[46][47][48][49].The health care provider inputs re ected several changes that occurred. They reported that the most important change was increased capacitated staff in study period II and even more so in period III due to dedicated mentorship.…”