Combining bottleneck analysis and quality improvement as a novel methodology to improve the quality of neonatal care in a northeastern state of India: a feasibility study

Datta, Vikram; Srivastava, Sheela; Garde, Rahul; Tluangi, Lalrin; Giri, Hunsi; Sangma, Sangeeta; Burman, Himesh; Pahwa, Parika; Pemde, Harish; Livesley, Nigel

doi:10.1093/inthealth/ihy062

Cited by 6 publications

(4 citation statements)

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“…The primary comparison of baseline and end-line data will be made by applying tests of statistical significance where applicable, with a level of significance established at p = 0.05. Moreover, bottleneck analysis will be done using appropriate models for the surveillance system in place and finding of this study will be published in open access journal upon completion of study [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

One Health approach for elimination of human anthrax in a tribal district of Odisha: Study protocol

et al. 2021

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Background Anthrax is a major but neglected zoonotic disease of public health concern in India with Odisha contributing a major share to the disease burden. Bacillus anthracis spores can be found naturally in soil and commonly affect both animals and humans around the world. Domestic and wild animals such as cattle, sheep, goats, and deer can become infected when they inhale or ingest spores from contaminated soil, plants, or water. Anthrax can be fatal if patients are not treated promptly with antibiotics. This protocol aims to describe the implementation and evaluation of the ‘One Health’ intervention model based on the principles of Theory of Change (ToC) to eliminate human anthrax from a tribal district in Odisha, India. Methods This study would test the effectiveness of a complex public health intervention package developed using the ToC framework for the elimination of human anthrax in Koraput district by a comparative analysis of baseline and end-line data. We plan to enroll 2640 adults across 14 geographically divided blocks in Koraput district of Odisha for baseline and end-line surveys. After baseline, we would provide capacity building training to stakeholders from the department of health, veterinary, forest, academic and allied health institutions followed by workshops on sensitization and awareness through IEC (Information Education Communication)/BCC (Behavior Change Communication) activities in the community. We would establish a state-level laboratory facility as a robust system for timely diagnosis and management of human anthrax cases. Surveillance network will be strengthened to track the cases in early stage and risk zoning will be done for focused surveillance in endemic areas. Advocacy with district level administration will be done for maximizing the coverage of livestock vaccination in the entire district. Interdepartmental coordination would be established for the effective implementation of the intervention package. Conclusion This would be a first study applying One Health concept for the elimination of human anthrax in India. The findings from this study will offer important insights for policy-making and further replication in other endemic regions of the state and country. Trial registration The authors confirm that all ongoing and related trials for this intervention are prospectively registered with the Clinical Trials Registry of India [CTRI/2020/05/025325] on 22 May 2020.

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Section: Methodsmentioning

confidence: 99%

One Health approach for elimination of human anthrax in a tribal district of Odisha: Study protocol

et al. 2021

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“…Reduced LONS rate by 43% and CLABSI rate by 36% in 1 year 15 Care Around Birth (CAB) bundles CAB bundle implementation practice improved from baseline value of 33%-47% to a sustained median value of 51%-61% for various components of the CAB bundle 28 Kangaroo Mother Care (KMC) Adoption & Scale-up Bundles Large-scale adoption can reduce the mortality in neonates by about 40%, especially in premature neonates 29 Perinatal Asphyxia Reduction Bundles…”

Section: Late-onset Neonatal Sepsis (Lons) Reduction Bundlesmentioning

confidence: 99%

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

Datta,

Srivastava,

Lalwani

et al. 2023

BMJ Open Qual

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IntroductionEnsuring quality of care in Low and Middle Income countries (LMICs) is challenging. Despite the implementation of various quality improvement (QI) initiatives in public and private sectors, the sustenance of improvements continues to be a major challenge. A team of healthcare professionals in India developed a digital community of practice (dCoP) focusing on QI which now has global footprints.MethodologyThe dCoP was conceptualised as a multitiered structure and is operational online atwww.nqocncop.orgfrom August 2020 onwards. The platform hosts various activities related to the quality of care, including the development of new products, and involves different cadres of healthcare professionals from primary to tertiary care settings. The platform uses tracking indicators, including the cost of sustaining the dCoP to monitor the performance of the dCoP.ResultSince its launch in 2020, dCoP has conducted over 130 activities using 13 tools with 25 940 registration and 13 681 participants. From April 2021, it has expanded to countries across the South-East Asia region and currently has participants from 53 countries across five continents. It has developed 20 products in four thematic areas for a targeted audience. dCoP is supporting mentoring of healthcare professionals from five countries in the South-East Asia region in their improvement journey. Acquiring new knowledge and improvement in their daily clinical practice has been reported by 93% and 80% of participants, respectively. The dCoP and its partners have facilitated the publication of nearly 40 articles in international journals.ConclusionThis dCoP platform has become a repository of knowledge for healthcare professionals in the South-East Asia region. The current paper summarises the journey of this innovative dCoP in an LMIC setting for a wider global audience.

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“…Some studies have taken the average duration of KMC in minutes or hours per baby per day. [20][21][22][23][24][25] While it gives collective unit performance over the day, it falsely indicates that if the mean duration is 6 hours, all the babies have received KMC. Adding further details to the numerator would therefore give a clear understanding of improved care.…”

Section: Measures Indicatormentioning

confidence: 99%

Quality improvement in Kangaroo Mother Care: learning from a teaching hospital

et al. 2022

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BackgroundKangaroo Mother Care (KMC) is a low-resource, evidence-based, high-impact intervention for low-birth weight (LBW) care. Quality improvement in KMC requires meso-level, macro-level and micro-level interventions. Our institution, a public teaching hospital, hosts a level-II/III neonatal intensive care unit (NICU). The average demand for beds typically exceeds available capacity, with 60% occupancy attributed to LBW patients. There was low uptake of KMC practice at our unit.Aim statementIn the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%–80% within 15 days. After a period of complacency, we revised the aim statement with a target of improving the percentage of babies receiving 6-hour KMC from 30% to 80% in 12 weeks.MethodsWe report this quasi-experimental time-series study. With the Point of Care Quality Improvement methodology, we performed Plan-Do-Study-Act (PDSA) cycles to improve KMC practice. We involved all the healthcare workers, mothers and caregivers to customise various KMC tools (KMC book format, KMC bag, mother’s gown) and minimise interruptions. Feedback from all levels guided our PDSA cycles.ResultsThe percentage of babies receiving at least 1-hour KMC increased from 20% to 100% within 15 days of August 2017. In the improvement phase, baseline 6-hour KMC coverage of 30% increased to 80% within 12 weeks (October–December 2017). It sustained for more than 2 years (January 2018 till February-2020) at 76.5%±2.49%.ConclusionsQuality improvement methods helped increase the coverage and percentage of babies receiving 6-hour KMC per day in our NICU. The duration specified KMC coverage should be adopted as the quality indicator of KMC. The training of healthcare workers and KMC provider should include hands-on sessions involving the mother and the baby. Maintaining data and providing suitable KMC tools are necessary elements for improving KMC. Minimising interruption is possible with family support and appropriate scheduling of activities. Having a designated KMC block helps in peer motivation.

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Combining bottleneck analysis and quality improvement as a novel methodology to improve the quality of neonatal care in a northeastern state of India: a feasibility study

Abstract: The combination of BNA and QI is a successful method for identifying and overcoming bottlenecks in newborn care in resource-limited settings.

Cited by 6 publications

References 28 publications

One Health approach for elimination of human anthrax in a tribal district of Odisha: Study protocol

One Health approach for elimination of human anthrax in a tribal district of Odisha: Study protocol

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

Quality improvement in Kangaroo Mother Care: learning from a teaching hospital

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