Quality of inpatient care of small and sick newborns in Pakistan: perceptions of key stakeholders

Abstract

Background In LMICs including Pakistan, neonatal health and survival is a critical challenge, and therefore improving the quality of facility-based newborn care services is instrumental in averting newborn mortality. This paper presents the perceptions of the key stakeholders in the public sector to explore factors influencing the care of small and sick newborns and young infants in inpatient care settings across Pakistan. Methods This exploratory study was part of a larger study assessing the situation of newborn and young infant in-patient care provided across all four provinces and administrative regions of Pakistan. We conducted 43 interviews. Thirty interviews were conducted with the public sector health care providers involved in newborn and young infant care and 13 interviews were carried out with health planners and managers working at the provincial level. A semi-structured interview guide was used to explore participants’ perspectives on enablers and barriers to the quality of care provided to small and sick newborns at the facility level. The interviews were manually analyzed using thematic content analysis. Findings The study respondents identified multiple barriers contributing to the poor quality of small and sick newborn care at inpatient care settings. This includes an absence of neonatal care standards, inadequate infrastructure and equipment for the care of small and sick newborns, deficient workforce for neonatal case management, inadequate thermal care management for newborns, inadequate referral system, absence of multidisciplinary approach in neonatal case management and need to institute strong monitoring system to prevent neonatal deaths and stillbirths. The only potential enabling factor was the improved federal and provincial oversight for reproductive, maternal, and newborn care. Conclusion This qualitative study was insightful in identifying the challenges that influence the quality of inpatient care for small and sick newborns and the resources needed to fix these. There is a need to equip Sick Newborn Care Units with needed supplies, equipment and medicines, deployment of specialist staff, strengthening of in-service training and staff supervision, liaison with the neonatal experts in customizing neonatal care guidelines for inpatient care settings and to inculcate the culture for inter-disciplinary team meetings at inpatient care settings across the country.

Nursing Care Practice in Neonatal Care Units of Tertiary Hospitals of Nepal: An Exploratory Qualitative Study

“…There was a universal practice for thermal care of PTIs having unstable temperatures using warming devices for thermal care. Previous studies in Ethiopia and Pakistan (Jebessa et al, 2021;Pradhan et al, 2021) reported inadequate practice regarding the availability of adequate warming devices. There was a universal practice of intermittent KMC and only one facility with resources for KMC (separate rooms and KMC beds) continued KMC practice.…”

“…Although PTI care practice in NCU is a collaborative and multidisciplinary team effort, nurses have the critical role of providing quality care (Moxon et al, 2015;WHO, 2019). Evidence has reported inadequate care practice in NCUs across developing countries, including South Asia and Africa (Jebessa et al, 2021;Moxon et al, 2015;Pradhan et al, 2021). A few research studies conducted in Nepal indicated a lack in some aspects of PTI care, such as kangaroo mother care (KMC), proper positioning, sleep protection, pain management, etc., in NCU (New et al, 2019;Salim et al, 2021).…”

Infant & Child Mortality in Pakistan and its Determinants: A Review

“…63 A significant number of infant deaths are also undocumented, which means that official statistics are merely underestimates. 64 , 65 Furthermore, the inadequate surveillance infrastructure has led to ineffective monitoring, and therefore management, of outbreaks of infectious diseases. 66 With a background of an already dire healthcare state, which enhances the risk of high child mortality.…”