How can we improve the care of small and sick newborns in low- and middle-income countries? Highlights of Discussion 1 (2017)

16 February, 2018
We recently held the first in a series of three online thematic discussions surrounding newborn care, hosted by CHIFA; please see our introduction article here for more information. 
Part 1 of this global conversation sought to develop a collective broad understanding of the current situation worldwide and the many gaps in care for newborns; this blog provides a summary of the online discussion, and see here for the Full Text, Long Edit and Short Edit.
Part 2 will look at the health system and the actual implementation of quality care for small and sick newborns – the models of care, infrastructure, equipment & commodities, and guidelines. How can we ensure accountability and measure care of small and sick newborns within all levels of the health system? We invite you to join CHIFA here in readiness for part 2, which will start on 19 February.
From 16 October to 24 November 2017 (including World Prematurity Day, 17 November), the online discussion involved 128 contributions from 41 contributors in 12 countries worldwide (Bangladesh, Canada, Ethiopia, Ghana, India, Kenya, Malawi, Nigeria, Rwanda, South Africa, UK, USA). Contributors included many of the world’s leading experts on newborn health as well as researchers, frontline health workers, and information professionals. This productive and stimulating discussion was structured around specific questions aiming to explore and address the quality of newborn care in low- and middle-income countries, particularly for those born small and sick.

1. What is the size of the problem? How many newborns die, where, and why? How many more suffer major morbidity? What are the trends?

According to latest UN estimates, 2.6 million newborns died in 2016 with 78% occurring in South Asia or sub-Saharan Africa. The three main causes of death include complications of preterm birth, complications during childbirth, and neonatal infections. New data on trends in mortality have been recently released by UNICEF, and the Every Preemie Preterm Birth/Low Birth Weight Country Profiles have also been recently updated . Healthy Newborn Network’s Newborn Numbers provides the latest global, country, and regional estimates related to neonatal survival downloadable as an excel spreadsheet or through a data visualization tool.

2. What do we know about quality of care (QOC) in the home, community and primary health centres? What level of care is available for small and/or sick newborns?

It is widely recognised that not only is resuscitation of non-breathing babies at birth important, but quality supportive aftercare to reduce death and the risk of disability. Such care needs to be provided in dedicated neonatal inpatient care units within facilities. There was an interesting debate regarding training traditional birth attendants (TBAs); in some settings they have chosen to focus on improving care in health facilities where deliveries increasingly occur, training skilled birth attendants rather than TBAs, whilst others recognise that TBA’s still attend a large proportion of deliveries and thus they should be trained in basic resuscitation and knowledge regarding when to refer, with strong linkages to facilities.

3. What do we know about QOC in district hospitals and referral hospitals? What level of care is available for small and/or sick newborns?

CHIFA members drew attention to quality of hospital care for preterm newborns. Retinopathy of prematurity rates have been increasing, as a result of both inappropriate use of oxygen with expansion of newborn services, as well as increasing premature infant survivors. For preterm babies, neonates with encephalopathy and others are at a high risk of developmental disability and growth problems. Follow up programmes and early intervention (which is standard practice in higher income settings) as well as support services for parents are urgently needed. This initiated a thought-provoking discussion surrounding family-centred care, which has been a relatively neglected concept especially in LMICs. The theme of family-centred care and different approaches to involve families in the care of their small and sick newborns will continue in the next part of the discussion.

4. In what ways are health workers empowered/ disempowered to provide adequate quality of care for newborns?

It was widely perceived that training of nurses in newborn care is woefully inadequate in many settings; too short, with a lack of specific standardised competencies, and too frequent rotations into other areas. Many settings do not recognise neonatal nurses as a specific cadre. Standardised guidelines, assessment tools and record-keeping are also lacking, and there is an urgent need to enhance health information systems for accurate data collection in order to improve our understanding of gaps in services, burden of disease, and to improve quality of care. Contributors also drew attention to the importance of improving obstetric care, especially in relation to neonatal sepsis and hypoxic brain injury, emphasising the importance of the continuum of care and complementary indicators to measure and monitor this care.
The second in this series of thematic discussions will commence on 19 February, and we invite you to join us and share your valuable experiences and opinions.
Acknowledgement: The above blog by Samantha Sadoo was originally published on the Healthy Newborn Network.