ABSTRACT
Background. Monitoring the health status of populations of children is one of the building blocks of the health system. The provision of an indicator dashboard with disaggregated data that are collected over time can be used to gauge the performance of the health system, guide the allocation of resources and prioritise health interventions within districts.Objectives. To determine neonatal and child mortality, morbidity and health service outcomes over a 6-year period in the Metro West geographic service area (GSA) of the Cape Town metropole.Methods. A dashboard with key indicators was developed using existing data.Results. From 2010 to 2015, there was a decrease in the perinatal mortality rate from 31.7 to 24.8 per 1 000 deliveries, and the early neonatal and neonatal mortality rates from 7.8 and 8.6 to 7.0 and 8.2 per 1 000 live births, respectively. The main obstetric causes of early neonatal deaths were antepartum haemorrhage (22 - 24%) and unexplained intrauterine death (13 - 16%); the main neonatal causes were immaturity (17 - 34%), congenital abnormalities (23 - 29%) and hypoxia (23 - 26%). Under-five mortality decreased in 2013 from 25 to 22 per 1 000 live births, with the main causes being neonatal conditions (32%), pneumonia (25%), congenital abnormalities (9%), injuries (8%) and diarrhoea (8%). Fifty percent of child deaths were out of hospital, with pneumonia and diarrhoea accounting for more than half of these. There was an improvement in health service coverage rates in 2015: immunisation <1 year old (99%); measles second dose (85%), pneumococcal third dose (100%) and rotavirus second dose (100%); maternal antiretroviral coverage (90%); HIV testing in mothers (93%); HIV DNA polymerase chain reaction testing in babies (97%); and a decrease in HIV transmission (2%). Exclusive breastfeeding coverage rates at 14 weeks, and vitamin A supplementation at 12 - 59 months, were only 30% and 44%,respectively, across the GSA.Conclusion. There was a decrease in perinatal, early neonatal, infant and under-five mortality in Metro West over the 6 years. Further reductions in under-five mortality will require focusing on interventions to reduce neonatal and out-of-hospital deaths across the service delivery platform. Home visits to at-risk mothers and infants by community health workers could prevent out-of-hospital deaths and improve exclusive breastfeeding and vitamin A coverage. This will require increasing the number of community health workers and broadening their scope of practice
Subject(s)
Delivery, Obstetric , Health Status , Infant, Newborn , South AfricaABSTRACT
Objectives: The objectives of this study were to assess nursing staff knowledge; attitudes and practices regarding the Baby-Friendly Hospital Initiative (BFHI); to assess the knowledge of maternity obstetric unit (MOU) managers regarding BFHI principles and their attitude towards BFHI implementation; and to describe the barriers and constraints to the implementation of BFHI principles. Study design: Cross-sectional descriptive survey. Setting: The study was done in eight non-BFHI-accredited primary care maternity obstetric units in Cape Town.Subjects: The subjects were eight MOU managers and a random sample of 45 nursing staff.Outcomes measures: Knowledge; attitude and practices regarding BFHI and barriers to BFHI implementation were assessed by an intervieweradministered questionnaire.Results: The study emonstrated acceptable awareness and knowledge of the recommended BFHI principles. A total of 56.6of the staff could define rooming-in; 47.2could define the components of the BFHI; and 52.8could name three baby-friendly care practices and routines. Eighty-nine per cent of the nursing staff were able to demonstrate correct positioning of the baby for breastfeeding; and 91.1could demonstrate the correct attachment of the baby to the breast. Only 8.9of the nursing staff were able to adequately demonstrate the correct hand milk-expressing technique; 35.6knew about the correct management of painful nipples and 22.2knew how to manage engorgement.Only 40could adequately describe the safe preparation of infant formula. The enrolled nursing assistants (ENA) were significantly less knowledgeable than the other cadres of nurses. The majority of the nurses had a positive attitude toward BFHI principles and practices
Subject(s)
Attitude , Breast Feeding , Nursing StaffABSTRACT
Objectives: The objectives of this study were to assess nursing staff knowledge; attitudes and practices regarding the Baby-Friendly Hospital Initiative (BFHI); to assess the knowledge of maternity obstetric unit (MOU) managers regarding BFHI principles and their attitude towards BFHI implementation; and to describe the barriers and constraints to the implementation of BFHI principles. Study design: Cross-sectional descriptive survey. Setting: The study was done in eight non-BFHI-accredited primary care maternity obstetric units in Cape Town.Subjects: The subjects were eight MOU managers and a random sample of 45 nursing staff.Outcomes measures: Knowledge; attitude and practices regarding BFHI and barriers to BFHI implementation were assessed by an intervieweradministered questionnaire.Results: The study emonstrated acceptable awareness and knowledge of the recommended BFHI principles. A total of 56.6of the staff could define rooming-in; 47.2could define the components of the BFHI; and 52.8could name three baby-friendly care practices and routines. Eighty-nine per cent of the nursing staff were able to demonstrate correct positioning of the baby for breastfeeding; and 91.1could demonstrate the correct attachment of the baby to the breast. Only 8.9of the nursing staff were able to adequately demonstrate the correct hand milk-expressing technique; 35.6knew about the correct management of painful nipples and 22.2knew how to manage engorgement.Only 40could adequately describe the safe preparation of infant formula. The enrolled nursing assistants (ENA) were significantly less knowledgeable than the other cadres of nurses. The majority of the nurses had a positive attitude toward BFHI principles and practices
Subject(s)
Attitude , Breast Feeding , Nursing StaffABSTRACT
Objectives: The objectives of this study were to assess nursing staff knowledge; attitudes and practices regarding the Baby-Friendly Hospital Initiative (BFHI); to assess the knowledge of maternity obstetric unit (MOU) managers regarding BFHI principles and their attitude towards BFHI implementation; and to describe the barriers and constraints to the implementation of BFHI principles.Study design: Cross-sectional descriptive survey. Setting: The study was done in eight non-BFHI-accredited primary care maternity obstetric units in Cape Town.Subjects: The subjects were eight MOU managers and a random sample of 45 nursing staff.Outcomes measures: Knowledge; attitude and practices regarding BFHI and barriers to BFHI implementation were assessed by an intervieweradministered questionnaire.Results: The study demonstrated acceptable awareness and knowledge of the recommended BFHI principles. A total of 56.6 of the staff could define rooming-in; 47.2 could define the components of the BFHI; and 52.8 could name three baby-friendly care practices and routines. Eighty-nine per cent of the nursing staff were able to demonstrate correct positioning of the baby for breastfeeding; and 91.1 could demonstrate the correct attachment of the baby to the breast. Only 8.9 of the nursing staff were able to adequately demonstrate the correct hand milk-expressing technique; 35.6 knew about the correct management of painful nipples and 22.2 knew how to manage engorgement. Only 40could adequately describe the safe preparation of infant formula. The enrolled nursing assistants (ENA) were significantly less knowledgeable than the other cadres of nurses. The majority of the nurses had a positive attitude toward BFHI principles and practices