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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.


Performance indices comparison across all centres. NNMR stands for neonatal mortality rate, NNMRexcl.d48 for neonatal mortality rate excluding babies dying within 48 hours of presentation, and IDNMR for incubator-dependent-neonate mortality rate.
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Related In: Results  -  Collection


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fig13: Performance indices comparison across all centres. NNMR stands for neonatal mortality rate, NNMRexcl.d48 for neonatal mortality rate excluding babies dying within 48 hours of presentation, and IDNMR for incubator-dependent-neonate mortality rate.

Mentions: We are not able to accurately quantify the relative contribution of each concern remedy towards the overall lowering of NNMR as these top centres applied varying levels of priority to different concerns. For example, the FMC Owerri was enabled to execute up to 7 concerns but particularly favoured continuous retraining of their SCBU staff while LUTH Lagos maximised 5 concerns and particularly favoured incubator capacity expansion up to 38 units of functional incubators and 8 units of Resuscitaires. This boosted LUTH's overall baby influx, a turnover of over 150 neonates in some months between patients being admitted in the “out-born,” “in-born.” and “paediatric-surgery” sections. FMC Nguru maximised all available remedies on the outreach without necessarily delimiting any. The admission registers of these high performing centres revealed higher influx of neonates as compared to situations prior to the present outreach. Overall baby admission at our control was comparable to other centres and had the third largest neonatal admissions (Figure 12). This suggested that the population within the catchment zone of this hospital had significant willingness to seek specialist intervention. However our control recorded the least relative number of IDN presentations amongst the admitted babies. This indicates a higher hesitation in the presentation of IDN babies to the control centre despite the people's good level of willingness to seek the hospital, perhaps as a result of very low success rate (Figure 13). The control centre (CC) saved the least number of IDNs (74 neonates) amongst the 5 individual centres over the 2-year period that was analysed. This was far smaller than the worst record from any of our outreach centres despite the control's locational and academic advantages as a teaching hospital (Figure 14). The clinical team at our control centre argued that the reasons for the poor outcomes “might be due to depletion of both infrastructure and skilled manpower as most of the incubators in our SCBU were broken down and the few functioning are in serious need of maintenance; also skilled nurses who have training in neonatal care were seldom given the opportunity to remain in the neonatal ward due to reshovelling of nurses around departments irrespective of the special training a nurse might have.”


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)

Performance indices comparison across all centres. NNMR stands for neonatal mortality rate, NNMRexcl.d48 for neonatal mortality rate excluding babies dying within 48 hours of presentation, and IDNMR for incubator-dependent-neonate mortality rate.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig13: Performance indices comparison across all centres. NNMR stands for neonatal mortality rate, NNMRexcl.d48 for neonatal mortality rate excluding babies dying within 48 hours of presentation, and IDNMR for incubator-dependent-neonate mortality rate.
Mentions: We are not able to accurately quantify the relative contribution of each concern remedy towards the overall lowering of NNMR as these top centres applied varying levels of priority to different concerns. For example, the FMC Owerri was enabled to execute up to 7 concerns but particularly favoured continuous retraining of their SCBU staff while LUTH Lagos maximised 5 concerns and particularly favoured incubator capacity expansion up to 38 units of functional incubators and 8 units of Resuscitaires. This boosted LUTH's overall baby influx, a turnover of over 150 neonates in some months between patients being admitted in the “out-born,” “in-born.” and “paediatric-surgery” sections. FMC Nguru maximised all available remedies on the outreach without necessarily delimiting any. The admission registers of these high performing centres revealed higher influx of neonates as compared to situations prior to the present outreach. Overall baby admission at our control was comparable to other centres and had the third largest neonatal admissions (Figure 12). This suggested that the population within the catchment zone of this hospital had significant willingness to seek specialist intervention. However our control recorded the least relative number of IDN presentations amongst the admitted babies. This indicates a higher hesitation in the presentation of IDN babies to the control centre despite the people's good level of willingness to seek the hospital, perhaps as a result of very low success rate (Figure 13). The control centre (CC) saved the least number of IDNs (74 neonates) amongst the 5 individual centres over the 2-year period that was analysed. This was far smaller than the worst record from any of our outreach centres despite the control's locational and academic advantages as a teaching hospital (Figure 14). The clinical team at our control centre argued that the reasons for the poor outcomes “might be due to depletion of both infrastructure and skilled manpower as most of the incubators in our SCBU were broken down and the few functioning are in serious need of maintenance; also skilled nurses who have training in neonatal care were seldom given the opportunity to remain in the neonatal ward due to reshovelling of nurses around departments irrespective of the special training a nurse might have.”

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.