Facility Assessment of Quality of Care for Essential Newborn Care and Neonatal Resuscitation

1. Facility Assessment of Quality of Care for Essential Newborn Care and Neonatal Resuscitation in selected African Countries Dr. Joseph de Graft-Johnson, MCHIP/Save the Children Newborn Team Leader

2. Acknowledgments Ministries of Health and staff of the study facilities in Ethiopia, Madagascar, Rwanda, and United Republic of Tanzania Data collection teams in each country Research team for MCHIP: Jim Ricca, Barbara Rawlins, Linda Bartlett, David Cantor, Patricia Gomez, Heather Rosen, Bob Bozsa MCHIP\jhpiego headquarters and in-country staff, Tandem consulting (Madagascar) 2

3. Presentation outline Summary of the newborn sample Newborn care equipment & supplies inventory findings immediate newborn care findings Neonatal resuscitation results Conclusions

4. Summary of newborn care sample Surveyed 177 facilities in 4 countries; observed ~2500 deliveries and ANC consults, and interviewed ~600 health workers 4

5. Inventory of supplies for immediate newborn care (n=177) 5

6. Inventory of supplies for management of newborn complications 54% of facilities had gentamycin and ampicillin with wide range by country (29-67%) 6

7. Essential newborn care: from policy to practice (1) SDGs covers all elements of ENC, data missing for Tanzania and Rwanda; (2) births attended by skilled attendants; (3) facilities stocked with cord ties, sterile scissors, towel/blanket (all 3); (4) personnel knowledgeable in immediate newborn care; (5) personnel received supervision within last 3 months 7

8. Observation of immediate newborn care (n=1095) (1) Ethiopia: cuts and ties/clamps cord, protecting newborn from blade or scissors 24% of deliveries (range 17-40%) received all essential newborn care elements (*)

9. Non-beneficial and un-indicated newborn care practices 9

10. Health worker knowledge of immediate newborn care and management of complication (n=423) (1) no data for Madagascar; (2) n=555, written test for Ethiopia, simulation for Tanzania, Rwanda, Madagascar 10 * Values are mean score

11. Newborn resuscitation simulations (1) Simulation: drying, place on warm clean surface, head in slightly extended position, suction with bulb or catheter in mouth or nose (all items) (2) Ventilation: place correct size mask covering chin, moth and nose, squeeze bag with 2 fingers or hand – appropriately, ventilate at 40 breathes/min (all items) (3) Adjustment is any proper adjustment: check neck position, check seal, repeat suction, squeeze harder 11

12. Management of Newborn Asphyxia 12

13. Conclusions Assumption that skilled birth attendance equal quality newborn care is obviously not true There is need to improve the quality of newborn care for infants delivered at health facilities A sizable percentage of health facilities have newborn resuscitation equipment but staff skills needs improvement Countries are committed to make these improvements and all must play their part to make it happen

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