The development and implementation of a newborn medicine program in a resource-limited setting

Hansen, Anne; Magge, Hema; Labrecque, Michelle; Munyaneza, Richard B. Mark; Nahimana, Evrard; Nyishime, Merab; Mwali, A.

doi:10.5588/pha.14.0106

Cited by 17 publications

(27 citation statements)

References 3 publications

(4 reference statements)

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“…Although the percentage of Rwandan women delivering in a health facility increased from 28% in 2005 to 69% in 2010 [ 10 ], evidence suggests numerous gaps in the quality of facility-based care during delivery and the early neonatal period [ 33 ]. Evidence-based policies and programs to improve neonatal care are underway, and this is an important area for future study [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data

Amoroso¹,

Nisingizwe²,

Rouleau³

et al. 2018

BMC Pediatr

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BackgroundSustained investments in Rwanda’s health system have led to historic reductions in under five (U5) mortality. Although Rwanda achieved an estimated 68% decrease in the national under U5 mortality rate between 2002 and 2012, according to the national census, 5.8% of children still do not reach their fifth birthday, requiring the next wave of child mortality prevention strategies.MethodsThis is a cross-sectional study of 9002 births to 6328 women age 15–49 in the 2010 Rwanda Demographic and Health Survey. We tested bivariate associations between 29 covariates and U5 mortality, retaining covariates with an odds ratio p < 0.1 for model building. We used manual backward stepwise logistic regression to identify correlates of U5 mortality in all children U5, 0–11 months, and 12–59 months. Analyses were performed in Stata v12, adjusting for complex sample design.ResultsOf 14 covariates associated with U5 mortality in bivariate analysis, the following remained associated with U5 mortality in multivariate analysis: household being among the poorest of the poor (OR = 1.98), child being a twin (OR = 2.40), mother having 3–4 births in the past 5 years (OR = 3.97) compared to 1–2 births, mother being HIV positive (OR = 2.27), and mother not using contraceptives (OR = 1.37) compared to using a modern method (p < 0.05 for all). Mother experiencing physical or sexual violence in the last 12 months was associated with U5 mortality in children ages 1–4 years (OR = 1.48, p < 0.05). U5 survival was associated with a preceding birth interval 25–50 months (OR = 0.67) compared to 9–24 months, and having a mosquito net (OR = 0.46) (p < 0.05 for both).ConclusionsIn the past decade, Rwanda rolled out integrated management of childhood illness, near universal coverage of childhood vaccinations, a national community health worker program, and a universal health insurance scheme. Identifying factors that continue to be associated with childhood mortality supports determination of which interventions to strengthen to reduce it further. This study suggests that Rwanda’s next wave of U5 mortality reduction should target programs in improving neonatal outcomes, poverty reduction, family planning, HIV services, malaria prevention, and prevention of intimate partner violence.

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Section: Discussionmentioning

confidence: 99%

Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data

Amoroso¹,

Nisingizwe²,

Rouleau³

et al. 2018

BMC Pediatr

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“…The Rwanda Ministry of Health (MOH) developed a national neonatal care protocol and standards in partnership with a number of organizations, including Partners In Health/Inshuti Mu Buzima (PIH/IMB) - an international non-profit organization committed to improving health services in impoverished communities - and specialists from Boston Children’s Hospital in Boston, USA. The neonatal care package was nationally adopted in 2012 with the goal of providing quality care to sick and preterm/low birth weight infants in rural district hospitals which lack specialist physicians [ 17 , 18 ]. The protocol was initially implemented and tested in the neonatal units of two rural PIH/IMB supported MOH district hospitals in 2010–2011.…”

Section: Introductionmentioning

confidence: 99%

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

Nyishime¹,

Borg²,

Ingabire³

et al. 2018

BMC Pediatr

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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.

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“…Medical education reform is a continuous process whose primary goal is to realign curricula with the needs of the healthcare system of the society [ 21 ]. Examples of curricula review can be found in limited resource settings too for example Rwanda [ 22 ] and India [ 23 ]. In both countries there was successful development and implementation of a neonatal training program aimed at general practitioners and nurses on a background of needs assessment findings of poorly standardized care and wide variation in practices from place to place.…”

Section: Discussionmentioning

confidence: 99%

Development of a neonatal curriculum for medical students in Zimbabwe – a cross sectional survey

et al. 2018

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BackgroundCalls have been made to reassess the curricula of medical schools throughout the world to adopt competence-based programs that address the healthcare needs of society. Zimbabwe is a country characterized by a high neonatal mortality rate of 24 per 1000 live births. The current research sought to determine the content and appropriate teaching strategies needed to guide the development of an undergraduate neonatal curriculum map for medical students at the University of Zimbabwe College of Health Sciences.MethodsWe surveyed faculty (n = 8) and non-faculty pediatricians (n = 5), senior resident medical officers (N = 26) using a self-administered questionnaire, and completed one focus group discussion with midwives (n = 11). We asked respondents their expectations regarding knowledge, psychomotor skills, competencies, and teaching strategies in a basic newborn curriculum for medical students. Relevant policy and curricula documents were reviewed to assess newborn health needs and the current training. A group of faculty educationists (n = 11) collated and finalized the findings from the document review, survey, and focus group using descriptive statistics and thematic analysis.ResultsThe document review revealed three key neonatal health objectives according to the current national maternal and neonatal health road map. These objectives are to be met using a four tier approach comprising (i) family planning (ii) focused antenatal care (iii) clean and safe delivery and (iv) basic and comprehensive emergency obstetric & neonatal care. Existing curriculum has 15 newborn topics taught in lecture style during the pediatric rotations, and five newborn care skills to be learned through observation. The existing curriculum is silent on desired competencies. In the current study 19 cognitive areas, 17 psychomotor skills and six competency domains were identified for an ideal neonatal curriculum for undergraduate students. A combination of teaching strategies including classroom, simulation and a clinical rotation were recommended.ConclusionThis study revealed a significant gap between the existing neonatal curriculum and the ideal curriculum as recommended by broad stakeholders in the context of national health care needs. Next steps are to complete the development and implementation of the proposed curriculum map to better align with the ideal state.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1194-2) contains supplementary material, which is available to authorized users.

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The development and implementation of a newborn medicine program in a resource-limited setting

Cited by 17 publications

References 3 publications

Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data

Next wave of interventions to reduce under-five mortality in Rwanda: a cross-sectional analysis of demographic and health survey data

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

Development of a neonatal curriculum for medical students in Zimbabwe – a cross sectional survey

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