Dear Neil,
Thank you for reading our paper https://www.ghspjournal.org/content/early/2023/01/11/GHSP-D-22-00099. Yes, these are problems in some LMICs. Ideally, we would like to have a trained physician do at least one round in the postnatal wards. The nurses/midwives in the postnatal wards too need to have the competency to care for *both *the mothers and babies. However, while many facilities in high income countries and a number of hospitals in LMICs do have these practices, a significant number of these facilities in LMICs including certain large hospitals do not always have adequate resources to implement them.
In fact, during the last few years when we carried out quality improvement activities related to decreasing severe hyperbilirubinemia in selected hospitals in Ghana, one of the first steps, among others including
education of mothers, that we initiated was having at least one round a day by any available category of physician working in the neonatal unit (Narayanan I et al, Facilitating QI activities Globally through Digital
Technology: Decreasing Severe Neonatal Hyperbilirubinemia at the Pediatric Academic Society Meeting, 2022 – now under preparation for publication).
This step was not easy but it did have an impact.
For the reasons we have outlined in the paper, we suggest having the three-tiered approach described for the care of newborns, that seem to exist only in very limited hospitals. We would appreciate also having
responses on this at-risk approach and the three tiered system *within the hospitals* from other readers interested in this area on their views on this topic.
Thanking you,
With kind regards,
Indira
Indira Narayanan MBBS, MD, FNNF, FIAP, FNAMS
Adjunct Professor, Pediatrics/Neonatology
Georgetown University Medical Center
Consultant, Global Maternal and Newborn Health and Nutrition
Email:
CHIFA profile: Indira Narayanan is currently Adjunct Professor, Pediatrics/Neonatology at the Georgetown University Medical Center, Washington DC, USA and Independent Consultant, Global Maternal and Newborn Health. Professional interests: Maternal and Newborn Health, research, improving newborn care with emphasis on compassionate/respectful quality of care, health policies, program implementation, capacity building, social and behavior change communication. Her research includes the seminal randomized controlled studies on proving for the first time in world literature the clinical implications of the anti-infective properties of raw and heated human milk in neonatal units carried out during her work of 20 years in India. inarayanan6 AT gmail.com
