Systematic scaling up of neonatal care in countries

Knippenberg, Rudolf; Lawn, Joy E; Darmstadt, Gary L.; Begkoyian, Geneviève; Fogstad, Helga; Walelign, Netsanet; Paul, Vinod K.

doi:10.1016/s0140-6736(05)71145-4

Cited by 200 publications

(161 citation statements)

References 32 publications

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“…11 Children born in poor countries have a higher risk of death and neonatal mortality rate is 19% to 44% higher in poor families. 10 In Brazil infant mortality rate fell by 50% between 1990 and 2008. The southern state of Rio Grande do Sul had a reduction from 26.2 deaths per 1,000 live births in 1990 to 13.1 in 2008.…”

Section: Introductionmentioning

confidence: 99%

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

et al. 2011

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OBJECTIVE:To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models. METHODS:Cohort study including 138,407 live births with birth certifi cates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis. RESULTS:The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1-and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain signifi cant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions. CONCLUSIONS:The use of multilevel models showed a small effect of contextual determinants on the neonatal mortality rate. There was found a positive association with the poverty rate in the general model, and the proportion of households with water supply among preterm newborns.

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Section: Introductionmentioning

confidence: 99%

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

et al. 2011

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“…The greatest success of life-saving interventions occurs when hospital and community-based activities are linked. 5 Sick and premature newborns who require specialized hospital care for their survival die because facilities and skills required for neonatal intensive care are usually unavailable in these countries.…”

Section: Introductionmentioning

confidence: 99%

The impact of improved neonatal intensive care facilities on referral pattern and outcome at a teaching hospital in Ghana

2008

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“…4 However, for maximum gains, simultaneous expansion of quality clinical care for newborn babies and their mothers is essential. 5 The impediments identified in provision of clinical care include: lack of skilled personnel, poor quality and delayed use of services, poor compliance with treatment and affordability barriers for the economically weak people. 3 Although the need to improve the quality and scaling up of clinical care has been identified, the task has been perceived as challenging, costly and time-consuming.…”

Section: Introductionmentioning

confidence: 99%

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Agarwal

Acharya

et al. 2006

J Perinatol

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Objective: To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.Study design: Before-and-after intervention trial setting: limited resource teaching hospital; Design: Before and after study.Interventions: A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses.Statistical methods: The categorical and continuous variables were compared with w 2 and two-tailed tests, respectively.Results: Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P ¼ 0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions.Conclusions: Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.

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Systematic scaling up of neonatal care in countries

Cited by 200 publications

References 32 publications

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

Determinantes contextuais da mortalidade neonatal no Rio Grande do Sul por dois modelos de análise

The impact of improved neonatal intensive care facilities on referral pattern and outcome at a teaching hospital in Ghana

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

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