Abstract:
Neonatal mortality remains a major global challenge.
Most neonatal deaths occur in low-income countries,
but it is estimated that over two-thirds of these
deaths could be prevented if achievable interventions
are scaled up. To date, initiatives have focused on
community and obstetric interventions, and there has
been limited simultaneous drive to improve neonatal
care in the health facilities where the sick neonates
are being referred. Few data exist on the process of
implementing of neonatal care packages and their
impact. Evidence-based guidelines for neonatal care in
health facilities in low-resource settings and direction
on how to achieve these standards of neonatal care
are therefore urgently needed. We used the WHO-Recommended
Quality of Care Framework to build a
strategy for quality improvement of neonatal care in a
busy government hospital in Eastern Uganda. Twelve key
interventions were designed to improve infrastructure,
equipment, protocols and training to provide two
levels of neonatal care. We implemented this low-cost,
hospital-based neonatal care package over an 18-month
period. This data-driven analysis paper illustrates how
simple changes in practice, provision of basic equipment
and protocols, ongoing training and dedicated neonatal
staff can reduce neonatal mortality substantially even
without specialist equipment. Neonatal mortality
decreased from 48% to 40% (P=0.25) after level 1 care
was implemented and dropped further to 21% (P<0.01)
with level 2 care. In our experience, a dramatic impact
on neonatal mortality can be made through modest
and cost-effective interventions. We recommend that
stakeholders seeking to improve neonatal care in low-resource
settings adopt a similar approach.
