Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data

Vesel, Linda; Manu, Alexander; Lohela, Terhi J.; Gabrysch, Sabine; Okyere, Eunice; Asbroek, A. H. A. ten; Hill, Zelee; Agyemang, Charlotte Tawiah; Owusu‐Agyei, Seth; Kirkwood, Betty

doi:10.1136/bmjopen-2012-002326

Cited by 44 publications

(56 citation statements)

References 29 publications

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“…The results of this study are similar to previous studies in low-income settings in terms of the lack of staff and essential equipment, 29 particularly in public facilities. [30][31][32] However, there were differences in the criteria used in assessing the quality of care compared with those used in a previous study, 24 that is, differences in number of signal functions for each category, no distinction of regular versus skilled health professionals, and no use of nonmedical functions.…”

Section: Discussionsupporting

confidence: 82%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

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Section: Discussionsupporting

confidence: 82%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…Previous clinical observational studies in Ghana,15 the Philippines,8 Nepal32 and Bangladesh33 have also identified gaps in the quality of newborn healthcare. A health facility assessment in rural Ghana highlighted major gaps in newborn care equipment and quality of newborn care as well as the importance of quality improvement 15.…”

Section: Discussionmentioning

confidence: 99%

“…A health facility assessment in rural Ghana highlighted major gaps in newborn care equipment and quality of newborn care as well as the importance of quality improvement 15. A recent study in the Philippines also found that bathing of the baby in the first 24 hours was common and placing the baby skin-to-skin was infrequent 8.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

et al. 2017

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ObjectiveTo present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills.DesignCross-sectional observational health facility assessment.SettingEthiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania.ParticipantsHealth workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed.Main outcome measuresIndicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation.ResultsSterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly.ConclusionsThe findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives.

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“…Newhints was able to build on a pre-existing group of lay health volunteers who were willing and able to expand their role and whom community members were willing to accept as counsellors in newborn care. Rates of key positive behaviours for newborn health, including facility-based births, were already fairly high at baseline, whereas the quality of newborn care in health facilities was poor 3, 39. The cost of increased use of health facilities attributable to Newhints was extremely low because only a few babies for whom care was sought were admitted to hospital, and because in our setting, the strategy did not increase usage rates for other services.…”

Section: Discussionmentioning

confidence: 74%

Cost and cost-effectiveness of newborn home visits: findings from the Newhints cluster-randomised controlled trial in rural Ghana

Pitt

Tawiah

Soremekun

et al. 2016

The Lancet Global Health

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SummaryBackgroundEvery year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5–18). We aimed to estimate the costs and cost-effectiveness of newborn home visits in a programme setting.MethodsWe prospectively collected detailed cost data alongside the Newhints trial, which tested the effect of a home-visits intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI −12 to 25%) in neonatal mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the first week of life by community-based surveillance volunteers. We calculated incremental cost-effectiveness ratios (ICERs) with Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-effectiveness planes and cost-effectiveness acceptability curves. We then modelled the potential cost-effectiveness for baseline neonatal mortality rates of 20–60 deaths per 1000 livebirths with use of a meta-analysis of effectiveness estimates.FindingsIn the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) community-based surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in 2009. Annual economic cost of implementation was US$203 998, or $0·53 per person. In the base-case analysis, the Newhints intervention cost a mean of $10 343 (95% CI 2963 to −7674) per newborn life saved, or $352 (95% CI 104 to −268) per discounted life-year saved, and had a 72% chance of being highly cost effective with respect to Ghana's 2009 gross domestic product per person. Key determinants of cost-effectiveness were the discount rate, protective effectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with the meta-analysis results, the ICER increased from $127 per life-year saved at a neonatal mortality rate of 60 deaths per 1000 livebirths, to $379 per life-year saved at a rate of 20 deaths per 1000 livebirths. The strategy had at least a 99% probability of being highly cost effective for lower-middle-income countries in all neonatal mortality rate scenarios modelled, and at least a 95% probability of being highly cost effective for low-income countries at neonatal mortality rates of 30 or more deaths per 1000 livebirths.InterpretationOur findings show that the seemingly modest mortality reductions achieved by a newborn home-visit strategy might in fact be cost effective. In Ghana, such strategies are also likely to be affordable. Our findings support recommendations from WHO and UNICEF that low-income and middle-income countries implement newborn home visits.FundingThe Bill & Melinda Gates Foundation, UK Department for International Development, WHO.

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Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data

Cited by 44 publications

References 29 publications

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

Cost and cost-effectiveness of newborn home visits: findings from the Newhints cluster-randomised controlled trial in rural Ghana

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