Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study

Abstract

Background The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh—2 Indian states with a respective population of 35 and 50 million. Methods and findings We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%–62%, p -value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%–8%), 15% (9%–24%), 4% (2%–8%) and 2% (1%–5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%–18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. Conclusions Our findings suggest differences in quality of neonatal intensive care and 28-day su...

The pattern of admission and outcome of neonates managed in the neonatal intensive care unit in a Sudanese hospital

“…12,13,19 However, lower percentages of neonatal sepsis were reported in Islamabad, Pakistan, Kano and Enugu state in Nigeria, Haryana, Bohal, Telangana and Andhra Pradesh and Maharashtra in India, Addis Ababa in Ethiopia and Tehran in Iran. 10,[22][23][24][25][26][29][30][31] On the contrary, higher percentages compared to our result were pointed out by a number of studies, for example; studies conducted in different parts of Ethiopia reported that sepsis is the most common cause of admission to the NICU and it represented 40.5%, 67.9% and 78.4% of admission diagnosis in eastern Ethiopia, northwest Ethiopia and Adama respectively. 4,15,16 Moreover, a study in south Sudan, showed that sepsis is the leading cause of admission with a 63.7% morbidity rate, and another study in Benin city in Nigeria reported sepsis to be the causes of admission of 38.6% (n=??)…”

“…Generally, it was estimated that 10% of newborn babies are expected to develop jaundice that need clinical treatment. 10,11,21,24,26,[30][31][32] Bilirubin-induced mortality was among the top causes of death in the ten countries with the highest mortality rates globally. 32 In contrast to the other cause of morbidities, most of the neonatal jaundice is unpreventable.…”

“…11 Moreover, studies in Islamabad, Pakistan, Ethiopia, Sudan and different parts of India, reported a range of 19 to 10% of morbidities due to birth asphyxia. [9][10][11][12][13]23,25,26,31 The relatively low percentage in our study may indicate that mothers in our study had good antenatal service also the doctors and nurses are able to provide a proper resuscitation for neonates.…”

“…19,23,24,34 Even lower mortality rates (ranging from 4-9%) were reported in Ethiopia, Telangana and Andhra Pradesh and Mandya, India, Hyderabad, Pakistan, Tabriz, Iran, Jordan and Australia. 4,11,13,14,16,17,31 The difference in case fatality can be explained by numerous factors including; the difference and distribution of morbidities in each study population, the difference in the socioeconomic status of each country, the number and the distribution of the qualified health care providers and medical equipment in different facilities and the level and the quality of care provided by the health institutions especially the obstetrics and neonatal care facilities. 18,19,23,26 For instance, study in Ethiopia attributed the death due to the neonatal respiratory distress to the lack of treatment modalities likes administration of surfactant and mechanical ventilation.…”

Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

“…The study site was two Indian states of Telangana and Andhra Pradesh, which have a slightly better socio-economic situation than India’s average [ 12 ]. The 60 participating hospitals included 28 public secondary hospitals, 6 public medical colleges, 20 private tertiary hospitals and 6 private medical colleges with high neonatal mortality rates as described elsewhere [ 19 ]. We included women seeking childbirth care and neonates admitted to NCUs.…”