The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa

Background: Neonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation). Aim: The aim of the study was to explore neonatologists' views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers. Setting: The setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape. Method: A qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used. Results: The themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governance Conclusion: The study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates. Contribution: The findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

Immediate Seven Day Outcomes and Risk Factors of Low Birth Weight Neonates at Referral Hospitals in Mwanza City, Tanzania in October 2020

Every year more than 20 million neonates worldwide are born with low birth weight (LBW) per year. Ninety-five percent of LBW births occur in developing countries. The aim of this study was to determine Immediate Seven Day Outcomes and Risk Factors of Low Birth Weight Neonates at Referral Hospitals in Mwanza City. MATERIALS AND METHODS This was a hospital based observational prospective cohort study of neonates with LBW whom were followed up for seven days in the neonatal wards at referral hospitals in Mwanza city. Maternal social-demographic, newborns clinical data and vitality outcomes were collected. Categorical and continuous variables were summarized and presented in tables or bar charts. Any p-value of < 0.05, at 95% confidence interval was regarded as statistically significant. RESULTS Total of 200 neonates with median age of 0.8 days at baseline were enrolled. Amongst 148 (74 %) had prolonged hospitalization; due to sickness 88 (59%), and 60 (40%) due to poor weight gain. Whereas, the remaining 42 (21%) were discharged and 10 (5%) died within seven days. Prolonged hospitalization was associated with family income (p-value= <0.001) and place of delivery (p-value = <0.001). African Journal of Health Sciences Volume 34, Issue No.4, July- August 2021 452 Neonatal death was associated with family income (p-value =0.035) and birth weight (p-value = 0.019). Early discharge associated with gestational age at first antenatal visit, family income, mode of delivery, APGAR score at one minute, time interval between delivery and admission and timing of medication initiation. CONCLUSION LBW neonates are at high risk of death and prolonged hospitalization due to sickness or due to poor weight gain. Associated factors of these outcomes were family income, place of delivery, birth weight, gestation age during first antenatal visit, mode of delivered and low APGAR score.

Factors contributing to neonatal admissions and outcomes at Effia Nkwanta regional hospital: January to December 2015

Objectives: To investigate factors contributing to neonatal admission outcomes at Effia Nkwanta Regional Hospital (ENRH) Method: All neonatal admissions to the Neonatal & Intensive Care Unit (NICU) of the hospital that were entered into the DHIMS2 database were extracted and complemented with additional information from patients' folder review. The data from the two sources were merged and analysed using SPSS version 21. Univariate and multivariate regression analysis was performed to identify factors associated with admission outcomes, taking statistical significance as p < 0.05. ARC-GIS version 10.1 was used to describe the geospatial distribution of health facilities referring to ENRH. Setting: Neonatal & Intensive Care Unit of ENRH Participants: All neonates admitted to NICU between January and December 2015. Intervention: None Results: Nine Hundred and Ninety-Three out of the 1150 neonatal admissions were entered into DHIMS2. Fifty-two percent were males, 57.3% were delivered through Caesarean Section, 72% were admitted within 2 days of birth, and 56.8% had normal birth weight. FiftyEight percent of the neonates were delivered at the ENRH, whilst 39.9% were referred from health facilities located within Sekondi-Takoradi Metropolis. At 1 minute, only 14% of the neonates had normal Apgar score (8-10), and this improved to 50% at 5 minutes. The main causes of neonatal admission were birth asphyxia 21.0%, followed by prematurity 17.5%, neonatal jaundice 17.1% and neonatal sepsis 14.5%. The death rate was 18% with more than 80% of the deaths occurring during the early neonatal period. More than 80% of deaths were due to four admission diagnoses: birth asphyxia, prematurity, neonatal jaundice, neonatal sepsis. Factors associated with adverse admission outcome are: low birth weight, delivery by Caesarean Section and low Apgar score at 5 minutes. Conclusions: The institution of appropriate interventions to reduce or manage the four major causes of adverse neonatal admission outcomes will significantly reduce neonatal mortality in the hospital

Knowledge and practice of essential newborn care among postnatal mothers in Addis Ababa City Health Centers, Ethiopia

Essential newborn care is a wide-ranging approach planned to improve the health of newborn through interventions after pregnancy. In Ethiopia, about 120,000 newborns die every year in the first weeks of life which accounts for 42% of all deaths of under-five mortality. Therefore this study is aimed to assess the knowledge and practice of essential newborn care practices among mothers in Addis Ababa, Ethiopia. A facility-based cross-sectional study was conducted amog the enroll 576 women in the first six weeks of post-partum who attending ANC in Addis Abeba Health facility. Written consent was obtained from each participated individuals before the actual data taken. Data were gathered by using pre tested standard questionnaire. The collected data were uploaded to computer using EpiData version 3.1. and the analysis was made through SPSS package version 21. Logistic regression was carried out to assess possible associations. The strength of association was measured at P<0.05 with 95% confidence interval. The study revealed that the level of essential newborn care practices was 38.8%. Education and advise about essential newborn care practices during and after birth by skilled birth attendants (OR=2.17, 95%, CI=1.42,3.31), home visit by health extension worker (OR=1.55, 95% CI=1.03,2.32) and place of delivery at health center (OR=7.69, 95% CI =1.32, 36.42), at private health facility (OR=9.18, 95% CI=1.32, 63.75) and government hospital (OR=6.68, 95% CI =1.32, 33.87) were found to have statistically significant association with essential newborn care practices. The result of this study has indicated that the level of essential newborn care practices was low. A home visit by health extension workers, the timing of postnatal care visit by skilled birth attendants, advice about essential newborn care practices during and after pregnancy and place of delivery were found to be independent predictors of essential newborn care practices in the study area. Government should take remedial action to improve newborn care practice

Competence of health care providers on care of newborns at birth in a level-1 health facility in Yaoundé, Cameroon

This is an observational study which was carried out at a level one health facility in Yaoundé from June to July 2009. The aim was to evaluate the competence of health care providers towards newborns' care at birth Methods Ten health care providers took care of three hundred and thirty-five pregnant women who were enrolled for the study after informed verbal consent in the delivery room. Results Out of 340 offspring delivered and taken care of, 179 (52.6%) were male and 161 (47.4%) were female. Only two out of ten health workers had a WHO Essential Newborn Care (ENC) training. None of them had received any refresher course for the past two years. The mean gestational age of women was 39.5±3.5 weeks. Resuscitation was carried out on 21 (6.2%) of the newborns including 7 (33.3%) who had birth asphyxia. Health care providers scored 100% in performing the following tasks: warming up the baby, applying eye drops, injecting vitamin K, identifying the neonate, searching for any apparent life threatening congenital malformations, preventing for infection after procedures and initiating breastfeeding. The score was 24% at neonatal resuscitation tasks. Low level of education was associated with poor competence on applying ENC tasks (p<0.001). Lack of WHO ENC training was associated with poor competence on ENC tasks (p<0.001) and poor skills on resuscitation (p=0.03). Conclusion There is a need to reinforce the capacity of health care providers by training in WHO ENC course with emphasis on providing skills on resuscitation in order to reduce the burden of neonatal intrapartum-related deaths