Using Helping Mothers Survive to Improve Intrapartum Care.

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries.

OBJECTIVE: To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. DESIGN: Cross-sectional observational health facility assessment. SETTING: Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. PARTICIPANTS: Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. MAIN OUTCOME MEASURES: Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. RESULTS: Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. CONCLUSIONS: The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives.

Safeguarding maternal and newborn health: improving the quality of postnatal care in Kenya.

OBJECTIVE: To assess changes in the quality of care following the introduction of a new postnatal package. DESIGN: Using a pre-test, post test design to observe client-provider interactions with women 0-6 weeks postpartum. SETTING: Four health facilities in a rural district, eastern Kenya. PARTICIPANTS: Health providers and postpartum women. INTERVENTION: Introduction of comprehensive postnatal package of care, with three targeted assessments within 48 h of birth, 1-2 weeks and 6 weeks, to providers working in maternity and maternal and child health clinics. Main outcome measure Improved quality of postnatal counselling. RESULTS: Increased mean scores for counselling on danger signs in the newborn (0.24-1.39) and infant feeding (1.33-2.19) were noted. The total quality of care index for the newborn increased overall but remained lower than desired (from 3.37 to 6.45 out of 11). Essential maternal care index improved (3.4-8.72 out of 23). More women accepted a family planning method at 6 weeks (35-63%). CONCLUSIONS: The introduction of new comprehensive postnatal care package improved performance of providers in counselling in maternal and newborn complications, infant feeding and family planning. Additional studies looking at the postpartum family planning needs for women living with HIV would also be useful. However, providers would benefit from additional clinical skills for managing maternal and newborn complications during the critical period following childbirth.