Assessing the health system's capacity to conduct neonatal resuscitation in Ethiopia.

BACKGROUND: Globally and nationally approximately a quarter of neonatal deaths and an unknown number of intrapartum stillbirths are attributed to intrapartum complications known as birth asphyxia. Simple stimulation and resuscitation can save many of these lives. OBJECTIVE: To describe the capacity of the Ethiopian health system to provide neonatal resuscitation with bag and musk. METHODS: Cross-sectional data were collected from 741 health facilities and one birth attendant at each facility was interviewed. This paper focuses on 711 nurses and midwives. Based on a guided interview, responses were converted into a knowledge index and we used multivariable linear regression to identify factors that predicted a high score. RESULTS: Nine out of 10 hospitals, but only 40% of health centers, had performed neonatal resuscitation in the three months prior to the survey. Barriers to performing neonatal resuscitation included missing essential equipment and inadequately trained staff. Half of the midwives interviewed reported having performed neonatal resuscitation in the past three months compared to only 20% of the nurses. After controlling for provider and facility characteristics, key predictors of a high knowledge score among providers were recent performance of neonatal resuscitation and geographic region. Whether the provider was a nurse or a midwife, was not associated with a higher knowledge score. CONCLUSION: Educators and program managers should insist on practical pre-service and in-service training, ensure the availability of equipment to perform neonatal resuscitation, and prioritize certain regions of the country for these interventions.

Assessing the Health System's Capacity to Conduct Neonatal Resuscitation in Ethiopia

Globally and nationally approximately a quarter of neonatal deaths and an unknown number of intrapartum stillbirths are attributed to intrapartum complications known as birth asphyxia. Simple stimulation and resuscitation can save many of these lives. To describe the capacity of the Ethiopian health system to provide neonatal resuscitation with bag and musk. Cross-sectional data were collected from 741 health facilities and one birth attendant at each facility was interviewed. This paper focuses on 711 nurses and midwives. Based on a guided interview; responses were converted into a knowledge index and we used multivariable linear regression to identify factors that predicted a high score. Nine out of 10 hospitals; but only 40of health centers; had performed neonatal resuscitation in the three months prior to the survey. Barriers to performing neonatal resuscitation included missing essential equipment and inadequately trained staff. Half of the midwives interviewed reported having performed neonatal resuscitation in the past three months compared to only 20of the nurses. After controlling for provider and facility characteristics; key predictors of a high knowledge score among providers were recent performance of neonatal resuscitation and geographic region. Whether the provider was a nurse or a midwife; was not associated with a higher knowledge score. Educators and program managers should insist on practical pre-service and in-service training; ensure the availability of equipment to perform neonatal resuscitation; and prioritize certain regions of the country for these interventions

Ethiopia's assessment of emergency obstetric and newborn care: setting the gold standard for national facility-based assessments.

OBJECTIVE: To describe the methods used to implement Ethiopia's 2008 emergency obstetric and newborn care services (EmONC) assessment; highlight how the collaborative process contributed to immediate integration of results into national and subnational planning; and explain how the experience informed the development of a set of tools providing best practices and guidelines for other countries conducting similar assessments. METHODS: A team of maternal and newborn health experts from the Federal Ministry of Health (FMOH), the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), together with representatives from the Ethiopian Society of Obstetricians and Gynecologists, provided technical guidance for the 18-month process and facilitated demand for and use of the assessment results. Eighty-four trained data collectors administered 9 data collection modules in 806 public and private facilities. Field work and data were managed by a private firm who, together with the core team, implemented a multi-layered plan for data quality. Columbia University's Averting Maternal Death and Disability Program provided technical assistance. RESULTS: Results were published in national and regional reports and in 1-page facility factsheets informing subnational planning activities. Assessment results-which have been published in journal articles-informed water infrastructure improvements, efforts to expand access to magnesium sulfate, and FMOH and UN planning documents. The assessment also established a permanent database for future monitoring of the health system, including geographic locations of surveyed facilities. CONCLUSION: Ethiopia's assessment was successful largely because of active local leadership, a collaborative process, ample financial and technical support, and rapid integration of results into health system planning.

Indicators for availability, utilization, and quality of emergency obstetric care in Ethiopia, 2008.

OBJECTIVE: To report on the availability and quality of emergency obstetric and newborn care (EmONC) in Ethiopia. METHODS: All licensed hospitals and health centers were visited and standard questionnaires were administered. In addition, a nonrandom systematic sample was taken of recent cesarean deliveries, partographs, and maternal deaths-and these cases were systematically reviewed. Health facilities were geocoded using geographic positioning system devices. RESULTS: Too few facilities provided EmONC to meet the UN standards of 5 per 500,000 population, both nationally and in all but 2 regions. Only 7% of deliveries took place in institutions of any type, and only 3% in facilities that routinely provided all the signal functions. Only 6% of women with obstetric complications were treated in any health facility, half of whom were treated in fully functional EmONC facilities. Nationwide, 0.6% of expected deliveries were by cesarean. The mortality rate for women with serious obstetric complications (case fatality rate) was 2%. The cause of death was unknown in 10% of cases, and 21% were due to indirect causes (primarily malaria, anemia, and HIV-related). CONCLUSION: None of the indicators met UN standards. Ethiopia faces many challenges--not least geography--with regard to improving EmONC. Nevertheless, the government places high priority on improvement and has taken (and will continue to take) action to achieve Millennium Development Goals 4 and 5. This comprehensive survey serves both as a road map for planning strategies for improvement and as a baseline for measuring the impact of interventions.