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Challenges and frugal remedies for lowering facility based neonatal mortality and morbidity: a comparative study.

Amadi HO, Osibogun AO, Eyinade O, Kawuwa MB, Uwakwem AC, Ibekwe MU, Alabi P, Ezeaka C, Eleshin DG, Ibadin MO - Int J Pediatr (2014)

Bottom Line: Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000.It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters.The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.

View Article: PubMed Central - PubMed

Affiliation: Department of Bioengineering, Imperial College London, South Kensington Campus, SW7 2AZ, UK.

ABSTRACT
Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one "control" were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.

No MeSH data available.


Concerns remedy implementation degrees. Scores: poor (0) to good (5).
© Copyright Policy - open-access
Related In: Results  -  Collection


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fig11: Concerns remedy implementation degrees. Scores: poor (0) to good (5).

Mentions: At the inception of invitation to submit data for a retrospective assessment of the present outreach, all the hospitals invited to submit raw-data accepted with enthusiasm promising to keep up with the provided deadline. However, many of these either failed to comply or out rightly excused themselves from the study for various weak reasons, some of which might have stemmed from the fear of exposing suspected relative poor performance. The few submissions however had the advantage of coming from hospitals in the southern, northern, and middle-belt of Nigeria, giving a good national coverage. Our present study has shown that there has been further improvement on the overall outcomes of facility-based performance indices of the outreach centres. Notably, the average NNMR within the facilities has dropped from the figure of 198/1000 as reported by Amadi et al. [14] to 114/1000 in the present study. This significant leap must have been a result of the unprecedented dedication to capacity expansion, training, and implementation of FAC audit reports by the centres that have been assessed. Analysis was initially designed to use a scoring technique to comparatively measure the performances of entire centres in each of the concerns and to relate these to their respective outcomes. Unfortunately, the analysed data came from just a few of the participating hospitals for which very strong conclusions might not be drawn. However these were the top performing hospitals in the use of the concern remedies (Figure 11), and clinical and nursing practices in the centres had not been altered in any other direction since the 2009 assessments of Amadi et al. [14]. Hence result could only demonstrate that these concerns were the very vital components that brought about a significant reduction in NNMR as compared to the control.


Challenges and frugal remedies for lowering facility based neonatal mortality and morbidity: a comparative study.

Amadi HO, Osibogun AO, Eyinade O, Kawuwa MB, Uwakwem AC, Ibekwe MU, Alabi P, Ezeaka C, Eleshin DG, Ibadin MO - Int J Pediatr (2014)

Concerns remedy implementation degrees. Scores: poor (0) to good (5).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4129921&req=5

fig11: Concerns remedy implementation degrees. Scores: poor (0) to good (5).
Mentions: At the inception of invitation to submit data for a retrospective assessment of the present outreach, all the hospitals invited to submit raw-data accepted with enthusiasm promising to keep up with the provided deadline. However, many of these either failed to comply or out rightly excused themselves from the study for various weak reasons, some of which might have stemmed from the fear of exposing suspected relative poor performance. The few submissions however had the advantage of coming from hospitals in the southern, northern, and middle-belt of Nigeria, giving a good national coverage. Our present study has shown that there has been further improvement on the overall outcomes of facility-based performance indices of the outreach centres. Notably, the average NNMR within the facilities has dropped from the figure of 198/1000 as reported by Amadi et al. [14] to 114/1000 in the present study. This significant leap must have been a result of the unprecedented dedication to capacity expansion, training, and implementation of FAC audit reports by the centres that have been assessed. Analysis was initially designed to use a scoring technique to comparatively measure the performances of entire centres in each of the concerns and to relate these to their respective outcomes. Unfortunately, the analysed data came from just a few of the participating hospitals for which very strong conclusions might not be drawn. However these were the top performing hospitals in the use of the concern remedies (Figure 11), and clinical and nursing practices in the centres had not been altered in any other direction since the 2009 assessments of Amadi et al. [14]. Hence result could only demonstrate that these concerns were the very vital components that brought about a significant reduction in NNMR as compared to the control.

Bottom Line: Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000.It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters.The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.

View Article: PubMed Central - PubMed

Affiliation: Department of Bioengineering, Imperial College London, South Kensington Campus, SW7 2AZ, UK.

ABSTRACT
Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one "control" were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.

No MeSH data available.