Quality of essential newborn care and neonatal resuscitation at health facilities in Afghanistan: a cross-sectional assessment

Abstract

ObjectiveTo assess readiness and quality of essential newborn care and neonatal resuscitation practices in public health facilities in Afghanistan.DesignCross-sectional assessment.Setting226 public health facilities in Afghanistan, including 77 public health facilities with at least five births per day (high-volume facilities) and 149 of 1736 public health facilities with fewer than five births per day (low-volume facilities).ParticipantsManagers of 226 public health facilities, 734 skilled birth attendants (SBAs) working at these facilities, and 643 women and their newborns observed during childbirth at 77 high-volume health facilities.Outcome measuresAvailability of knowledgeable SBAs, availability of supplies and compliance with global guidelines for essential newborn care and neonatal resuscitation practices.ResultsAt high-volume facilities, 569/636 (87.9%) of babies were dried immediately after birth, 313/636 (49.2%) were placed in skin-to-skin contact with their mother and 581/636 (89.7%) had their umbilical cord cut with a sterile blade or scissors. A total of 87 newborn resuscitation attempts were observed. Twenty-four of the 87 (27.5%) began to breath or cry after simply clearing the airway or on stimulation. In the remaining 63 (72.5%) cases, a healthcare worker began resuscitation with a bag and mask; however, only 54 (62%) used a correct size of mask and three babies died as their resuscitation with bag and mask was unsuccessful.ConclusionsThe study indicates room for improvement of the quality of neonatal resuscitation practices at public health facilities in Afghanistan, requiring only strengthening of the current best practices in newborn care. Certain basic and effective aspects of essential newborn care that can be improved on with little additional resources were also missing, such as skin-to-skin contact of the babies with their mother. Improvement of compliance with the standard newborn care practices must be ensured to reduce preventable newborn mortality and morbidity in Afghanistan.

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

“…This retrospective health facility record review is a subset of Afghanistan's National Maternal and Newborn Health Quality of Care Assessment , a cross-sectional health facility assessment conducted in 2016. The assessment was designed to examine health facility readiness for basic and comprehensive emergency maternal and newborn care, and assess quality of routine antenatal care, childbirth and postpartum care, and management of selected obstetric and newborn complications ( 12 , 18 – 20 ).…”

Essential Newborn Care Among Postnatal Mothers at Selected Health Centers in Eastern Province, Rwanda

“…Being discharged home with a small birth weight newborn, or delivering in the community, possesses a higher risk of neonatal mortality as indicated in the study in Uganda. [21] The neonatal mortality in our country and worldwide is mostly associated with premature and small birth weight newborns as a result of disturbed optimal thermal-regulation. [20] Then, it is unfortunate that many mothers in the present study had poor knowledge of thermoregulation in small babies.…”

Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia

“…The rate then increased to 30/1,000 live births in 2019 (12). Solving this problem requires an understanding of the national guidance on newborn care and further assessing facility readiness, health worker competencies, health worker-patient interactions, and work environments (13).…”