Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa.

Background: Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life. Purpose: The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa. Methods: Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method. Findings: Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision. Conclusion: Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.

A Handy Preterm Infant Incubator for Providing Intensive Care: Simulation, 3D Printed Prototype, and Evaluation.

Preterm infants encounter an abrupt delivery before their complete maturity during the third trimester of pregnancy. Polls anticipate an increase in the rates of preterm infants for 2025, especially in middle- and low-income countries. Despite the abundance of intensive care methods for preterm infants, such as, but not limited to, commercial, transport, embrace warmer, radiant warmer, and Kangaroo Mother Care methods, they are either expensive, lack the most essential requirements or specifications, or lack the maternal-preterm bond. This drove us to carry this original research and innovative idea of developing a new 3D printed prototype of a Handy preterm infant incubator. We aim to provide the most indispensable intensive care with the lowest cost, to bestow low-income countries with the Handy incubator's care, preserve the maternal -preterm's bond, and diminish the rate of mortality. Biomedical features, electronics, and biocompatible materials were utilized. The design was simulated, the prototype was 3D printed, and the outcomes were tested and evaluated. Simulation results showed the best fit for the Handy incubator's components. Experimental results showed the 3D-printed prototype and the time elapsed to obtain it. Evaluation results revealed that the overall performance of Kangaroo Mother Care and the embrace warmer was 75 ± 1.4% and 66.7 ± 1.5%, respectively, while the overall performance of our Handy incubator was 91.7 ± 1.6%, thereby our cost-effective Handy incubator surpassed existing intensive care methods. The future step is associating the Handy incubator with more specifications and advancements.

Shortfall of equipment for neonatal intensive care and the introduction of budget holding contracts.

As adequate allowance must be made for the costs of purchasing, maintaining, and updating equipment during the development of contracts the current standing of neonatal units with regard to available equipment was assessed. Data were collected as part of a one year prospective survey of the 17 perinatal units in the Trent region. Adequacy of provision of equipment for recognised intensive care cost was assessed using the recommendations of the British Paediatric Association and British Association of Perinatal Paediatrics. It was assumed that units without recognised intensive care cost had to be able to equip one cot to a standard of intensive care level 1 in the short term. Equipment more than 5 years old was considered likely to warrant replacement or major maintenance within the next two years. With these guidelines over 600,000 pounds would be required to provide sufficient equipment for all recognised level 1 intensive care cost and to allow units without funded cost to provide this level of care in the short term and to replace existing equipment more than 5 years old for these cost alone. This amount could be reduced by 25% by subdividing intensive care cost into levels 1 and 2, thereby reducing equipment requirements, but this would impair the units' ability to perform level 1 care at funded provision, which has already been shown to need expansion. Neither figure takes account of equipment requirements for infants requiring special care. In addition, no allowance has been made for purchase or update of ultrasound scanners or blood gas analysers. If the government's proposed reforms are to be implemented clinicians need to revise guidelines regarding essential equipment, and plans must be made to correct any existing shortfalls so that they do not become inherited financial liabilities for future budget holders.

Estimating the cots required for neonatal intensive care.

Estimates of the number of cots required for neonatal intensive care have been based on recommendations made in 1971 in the Sheldon report, and there is concern that the recommendations are now out of date. Therefore changes in the use of neonatal care within one health region (North-east Thames) during the years 1972, 1974, and 1976 have been examined. It was found that new developments in the sophisticated care of very small and sick babies have placed greater demands on cots and other resources. More babies of very low birthweights are now being cared for in the two units in the region and the average length of stay in hospital is increasing. Criteria have been refined and brought up to date to estimate the likely requirements for neonatal intensive care cots, taking into account recent developments in the care of small babies.