Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda

Abstract

Background Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes. Methods A pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests. Results NCUs were run by a median of 1 nurse [interquartile range (IQR):1–2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77–155] to 137 [IQR: 79–184]. Availability of advanced equipment improved (syringe pumps: 57–100 %, vital sign monitors: 51–100 % and CPAP machine: 14–100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001). Conclusions The ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.

Defining the Current Deployment of Neonatal Infusion Pumps in Low- and Lower-Middle-Income Countries: A Rapid Review

“…Only the results by Lelli Chiesa et al 28 and Tuyisenge et al. 29 discussed the actual usability of syringe pumps. These 2 results discussed how although some syringe pumps were available, most of the facilities lacked the disposable infusion sets that are required to utilize the pumps.…”

Implementing value-based healthcare using a digital health exchange platform to improve pregnancy and childbirth outcomes in urban and rural Kenya

“…Research on implementation and evaluation of MNCH service models in LMICs focusses mainly on output-based interventions, addressing single components or subsets of the VBHC framework, such as outcome measurements ( 16 – 18 ), performance-based payments ( 19 , 20 ), (data-driven) quality improvements ( 21 – 23 ) or redesigns of referral systems ( 24 , 25 ). In this paper we describe the development and implementation process of a value-based healthcare (VBHC) based digital MNCH care bundle called MomCare, developed by the international non-governmental organization (NGO) PharmAccess Foundation (PAF) specifically designed for LMICs.…”

Every breath counts: Lessons learned in developing a training NICU in Northern Tanzania

“…Any improvement in global neonatal outcomes requires rapidly increasing the implementation of evidencebased maternal and neonatal care in hospitals throughout low-and middle-income countries (LMICs) (8). Yet, many barriers exist including staffing constraints, cultural beliefs that extremely low birthweight (ELBW, <1,000 g) infants cannot survive, lack of neonatal knowledge and skillsets, poor provision of neonatal respiratory care, lack of appropriate medical equipment and medications, and competing healthcare priorities within health systems (7,(9)(10)(11). In this article we will share our journey in the development of an East African neonatal intensive care unit (NICU) and the subsequent effect on neonatal mortality.…”