Assessing Combined Longitudinal Mentorship and Skills Training on Select Maternal and Neonatal Outcomes in Rural and Urban Health Facilities in Malawi

Abstract

Introduction: Despite successful efforts to improve clinical access and skilled birth attendance in Malawi, it still faces high rates of maternal and neonatal mortality. In 2017, the UCSF-GAIN partnership began a nurse-midwifery clinical education and longitudinal mentorship program. While it has received positive reviews, it is unclear whether routinely collected indicators can assess such a program’s impact. Method: A longitudinal review of the Malawian DHIS2 database explored variables associated with maternal and newborn care and outcomes before and after the intervention. Data were analyzed using generalized estimating equations (GEE) to account for facility-level correlations over time. Results: Quality issues with DHIS2 data were identified. Significant changes potentially associated with the GAIN intervention were noted. Discussion: The GAIN approach appears to be associated with positive trends in maternal and neonatal care. National summary databases are problematic, however, for evaluating targeted interventions and the provision of care to specific outcomes.

Establishment of a neonatal nursery in a rural district hospital in Malawi: A retrospective review of neonatal outcomes in Neno District Hospital (2014 - 2021)

“…However, there remain opportunities for improvement in the quality of care. Overall, this study, supported by other studies in similar settings, suggests improved care and outcomes of neonates born at a secondary district hospital with decentralized capacity building[21,22,25,54,55,56].Despite this, increased capacity of the staff through clinical skills training followed by longitudinal bedside mentorship, quality improvement of care in maternal and neonatal care such as perinatal monitoring and neonatal resuscitation may improve outcomes in similar settings[30,59]. Further quality improvement work and studies are required to identify speci c interventions and diagnostics that most…”

“…For example, despite 90% of deliveries occurring in a health facility in Malawi [19], many vital inputs to reduce neonatal mortality are missing, likely linked to the slowed neonatal mortality rate [20]. Until approximately 10 years ago in Malawi, most hospital neonatal care was only located at four urban central hospitals, while > 80% of the population lives in rural areas [21]. Over the past decade, almost all district hospitals have implemented a decentralized secondary hospital-based neonatal nursery, with evidence suggesting improved neonatal outcomes at these neonatal nurseries at the district level with accessibility to a larger proportion of the population [22][23][24][25][26].…”

“…While the neonatal nursery at NDH has been established for over seven years, there has yet to be a comprehensive evaluation of neonatal outcomes in Neno district, but other districts in Malawi have shown improved neonatal outcomes with the creation of neonatal nurseries [21]. A related study [27], conducted as an initial impact evaluation from January to July 2016, found 146 admissions and high rates of sepsis and birth asphyxia with increased use of respiratory support.…”

Impact of a Longitudinal Mentorship Intervention on the Documentation of Maternal Vital Signs in Blantyre District, Malawi

“…6 In this way, the longitudinal mentorship component of the intervention appeared to prove bene cial despite shortages by scaling up current evidence-based approaches among staff, aligning with prior ndings. 14 While not directly measured in our study, meaningfully supporting providers has also been shown to be critical to ensuring respectful care on the experience side of QoC. 4,23 The discrepancies seen between health centres were not necessarily surprising.…”

“…The government both supports research on the topic and recently implementing an adapted WHO Safe Childbirth Checklist (SCC) tool to assess maternal care with the support of multidisciplinary partners. 13,14 Still, ndings show clear challenges and areas for improvement. A nationally representative assessment of centre delivery care demonstrated that peripheral health centres lag behind larger health care centres and hospitals in QoC.…”