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Vallely LH, Shalit A, Nguyen R, Althabe F, Pingray V, Bonet M, Armari E, Bohren M, Homer C, Vogel JP. Intrapartum care measures and indicators for monitoring the implementation of WHO recommendations for a positive childbirth experience: a scoping review. BMJ Open 2023; 13:e069081. [PMID: 37993161 PMCID: PMC10668293 DOI: 10.1136/bmjopen-2022-069081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/29/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE We aimed to identify all available studies describing measures or indicators used to monitor 41 intrapartum care practices described in the 2018 WHO intrapartum care recommendations, with a view to informing development of standardised measurement of implementing these recommendations. DESIGN Systematic scoping review. METHODS We conducted a scoping review to identify studies reporting measures of intrapartum care published between 1 January 2000 and 28 June 2021. Primary and secondary outcome measures included study characteristics (publication year, journal, country and World Bank classification) and intrapartum care measure characteristics (definition, numerator, denominator, measurement level and measurement approach). We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, the Maternity and Infant Care Database, Global Index Medicus and grey literature using structured search terms related to included recommendations, focusing on respectful and supportive care, and clinical practices performed throughout labour and birth. The measures identified were classified by the WHO recommendation and their characteristics reported. RESULTS We identified 150 studies which described 1331 intrapartum care measures. These measures corresponded to 35 of the 41 included WHO recommendations, and represented all domains of the WHO recommendations (care throughout labour and birth, first stage of labour, second stage of labour, third stage of labour). A total of 40.1% (534 of 1331 measures) of measures were related to respectful maternity care. Most studies used a questionnaire or survey measurement approach (522 of 1331 measures, 39.2%). CONCLUSION This scoping review presents a database of existing intrapartum care measures used to monitor the quality of intrapartum care globally. There is no clear consensus on a core set of measures for evaluating the practice of the WHO's intrapartum care recommendations. This review provides a foundation to support the development of a core set of internationally standardised intrapartum care measures for the WHO intrapartum care recommendations, highlighting key areas requiring consensus and validation, and measure development.
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Affiliation(s)
- Lauren Hannah Vallely
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Shalit
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renae Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Fernando Althabe
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Elizabeth Armari
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Meghan Bohren
- Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Joshua Peter Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Malik AA, Ahmed N, Shafiq M, Elharake JA, James E, Nyhan K, Paintsil E, Melchinger HC, Team YBI, Malik FA, Omer SB. Behavioral interventions for vaccination uptake: A systematic review and meta-analysis. Health Policy 2023; 137:104894. [PMID: 37714082 PMCID: PMC10885629 DOI: 10.1016/j.healthpol.2023.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries. METHODS We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately. FINDINGS Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes. INTERPRETATION Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.
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Affiliation(s)
- Amyn A Malik
- Yale Institute for Global Health, New Haven, CT 06510, USA; Analysis Group, Inc, Boston, MA 02199, USA
| | - Noureen Ahmed
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Mehr Shafiq
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University School of Public Health, New York, NY 10032, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT 06510, USA; UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA; The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Erin James
- Yale Institute for Global Health, New Haven, CT 06510, USA
| | - Kate Nyhan
- Yale University, New Haven, CT 06510, USA
| | - Elliott Paintsil
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University Institute of Human Nutrition, New York, NY 10032, USA
| | | | | | - Fauzia A Malik
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Saad B Omer
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA.
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Galle A, Moran AC, Bonet M, Graham K, Muzigaba M, Portela A, Day LT, Tuabu GK, Silva BDSÉ, Moller AB. Measures to assess quality of postnatal care: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001384. [PMID: 36963034 PMCID: PMC10021656 DOI: 10.1371/journal.pgph.0001384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
High quality postnatal care is key for the health and wellbeing of women after childbirth and their newborns. In 2022, the World Health Organization (WHO) published global recommendations on maternal and newborn care for a positive postnatal care experience in a new WHO PNC guideline. Evidence regarding appropriate measures to monitor implementation of postnatal care (PNC) according to the WHO PNC guideline is lacking. This scoping review aims to document the measures used to assess the quality of postnatal care and their validity. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened and appraised identified articles. All data on PNC measures were extracted and mapped to the 2022 WHO PNC recommendations according to three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. We identified 62 studies providing measures aligning with the WHO PNC recommendations. For most PNC recommendations there were measures available and the highest number of recommendations were found for breastfeeding and the assessment of the newborn. No measures were found for recommendations related to sedentary behavior, criteria to be assessed before discharge, retention of staff in rural areas and use of digital communication. Measure validity assessment was described in 24 studies (39%), but methods were not standardized. Our review highlights a gap in existing PNC measures for several recommendations in the WHO PNC guideline. Assessment of the validity of PNC measures was limited. Consensus on how the quality of PNC should be measured is needed, involving a selection of priority measures and the development of new measures as appropriate.
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Affiliation(s)
- Anna Galle
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Allisyn C Moran
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Mercedes Bonet
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
| | - Katriona Graham
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Moise Muzigaba
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Anayda Portela
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology, Maternal Newborn Health Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Godwin Kwaku Tuabu
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Bianca De Sá É Silva
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Ann-Beth Moller
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
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Nguyen TT, Cashin J, Tran HT, Hoang TA, Mathisen R, Weissman A, Murray JCS. Birth and newborn care policies and practices limit breastfeeding at maternity facilities in Vietnam. Front Nutr 2022; 9:1041065. [PMID: 36407547 PMCID: PMC9668009 DOI: 10.3389/fnut.2022.1041065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/10/2022] [Indexed: 09/29/2023] Open
Abstract
The prevalence of early and exclusive breastfeeding in Vietnam remains sub-optimal. The objective of this study was to determine factors associated with early initiation of breastfeeding (EIBF) and exclusive breastfeeding for the first 3 days after birth (EBF3D). We conducted a population-based, cross-sectional survey of 726 mothers with children aged 0-11 months in two provinces and one municipality from May to July 2020. Multinomial logistic regression was used to examine factors associated with EIBF and EBF3D. The prevalence of EIBF was 39.7% and EBF3D 18.0%. The EIBF prevalence is positively associated with immediate and uninterrupted skin-to-skin contact (SSC) for 10-29 min (aOR: 2.55; 95% CI: 1.49, 4.37), 30-59 min (aOR: 4.15; 95% CI: 2.08, 8.27), 60-80 min (aOR: 4.35; 95% CI: 1.50, 12.6), or ≥90 min (aOR: 5.87; 95% CI: 3.14, 10.98). EIBF was negatively associated with cesarean birth (aOR: 0.24; 95% CI: 0.11, 0.51), bringing infant formula to the birth facility (aOR: 0.49; 95% CI: 0.30, 0.78), purchased it after arrival (aOR: 0.37; 95% CI: 0.24, 0.60), or did both (aOR: 0.43; 95% CI: 0.21, 0.89). EBF3D was negatively associated with cesarean section birth (aOR: 0.15; 95% CI: 0.06, 0.39), vaginal birth with episiotomy (aOR: 0.40; 95% CI: 0.18, 0.88), bringing formula to the maternity facility (aOR: 0.03; 95% CI: 0.01, 0.07), purchased it after arrival (aOR: 0.02; 95% CI: 0.01, 0.06) or did both (aOR: 0.04; 95% CI: 0.02, 0.10). Receiving counseling from any source was not significantly associated with early breastfeeding practices. Policy and health service delivery interventions should be directed at eliminating infant formula from birthing environments, reducing unnecessary cesarean sections and episiotomies, providing immediate and uninterrupted SSC for all births, and improving breastfeeding counseling and support.
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Affiliation(s)
- Tuan T. Nguyen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
| | - Jennifer Cashin
- Alive & Thrive East Asia Pacific, FHI 360, Washington, DC, United States
| | - Hoang T. Tran
- Neonatal Unit and Human Milk Bank, Department of Pediatrics, School of Medicine and Pharmacy, Da Nang Hospital for Women and Children, The University of Da Nang, Da Nang, Vietnam
| | - Tuan A. Hoang
- Department of Maternal and Child Health, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Roger Mathisen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
| | - Amy Weissman
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
- Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
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Tantengco OAG, Velayo CL. Episiotomy practice and perineal trauma in the Philippines. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 19:100381. [PMID: 35118435 PMCID: PMC8792258 DOI: 10.1016/j.lanwpc.2022.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Clarissa L. Velayo
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of the Philippines – Philippine General Hospital, Taft Avenue, Manila, Philippines
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Fekadu B, Ali I, Tafesse Z, Segni H. Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia. BMC Pregnancy Childbirth 2022; 22:37. [PMID: 35034632 PMCID: PMC8761277 DOI: 10.1186/s12884-021-04358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Even though Ethiopia has endorsed the implementation of ENC, as other many counties, it has been challenged. This study was conducted to measure the level of essential newborn care practice and identify health facility level attributes for consistent delivery of ENC services by health care providers. METHODS This study employed a retrospective cross-sectional study design in 425 facilities. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p < 0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders. RESULTS A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors-availability of essential obstetrics drugs in delivery rooms, high community score card (CSC) performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of consistent delivery of essential newborn care (CD-ENC) was consistent partograph use, recording an odds ratio of 2.66 (AOR = 2.66, 95%CI: 1.71, 4.13). Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 (AOR = 1.88, 95%CI: 1.15, 3.08) times higher odds of exhibiting consistent delivery of ENC. CONCLUSION The delivery of essential newborn care depends on both health provider and facility manager actions and availability of platforms to streamline relationships between the clients and health facility management.
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Affiliation(s)
- Binyam Fekadu
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia.
| | - Ismael Ali
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia
| | - Zergu Tafesse
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia
| | - Hailemariam Segni
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia
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van Schothorst-van Roekel J, Weggelaar-Jansen AMJWM, Hilders CCGJM, Wallenburg I, de Bont A. Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses' role development: a qualitative study. BMJ Open 2021; 11:e051998. [PMID: 34489293 PMCID: PMC8422484 DOI: 10.1136/bmjopen-2021-051998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Nurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses' QI competencies and studied how these roles influenced nurses and management. DESIGN An exploratory ethnographical study comprising observations, informal conversations, semistructured interviews, focus groups and a strategy evaluation meeting. SETTING A teaching hospital in an urban region in the Netherlands. PARTICIPANTS IPAs (n=7) in collaboration with four teams of nurses (n=131), team managers (n=4), senior managers (n=4) and the hospital director (n=1). RESULTS We identified five distinct advisory roles that IPAs perform in the hospital programme: gatekeeper, connector, converter, reflector and implementer. In describing these roles, we provide insights into how IPAs help nurses to develop QI competencies. The IPA's professional background was a driving force for nurses' QI role development. However, QI development was threatened if IPAs lost sight of different stakeholders' interests and consequently lost their credibility. QI role development among nurses was also threatened if the IPA took on all responsibility instead of delegating it timely to managers and nurses. CONCLUSIONS We have shown how IPAs' professional background and advisory knowledge connect organisational, managerial and professional aims and interests to enhance professionalisation of nurses.
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Affiliation(s)
| | | | - Carina C G J M Hilders
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Antoinette de Bont
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
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Calibo AP, De Leon Mendoza S, Silvestre MA, Murray JCS, Li Z, Mannava P, Kitong J, Quiazon MB, Sobel HL. Scaling up kangaroo mother care in the Philippines using policy, regulatory and systems reform to drive changes in birth practices. BMJ Glob Health 2021; 6:bmjgh-2021-006492. [PMID: 34417273 PMCID: PMC8381328 DOI: 10.1136/bmjgh-2021-006492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/20/2021] [Indexed: 11/03/2022] Open
Abstract
The WHO recommends kangaroo mother care (KMC) for stable preterm and low birthweight babies because it has been demonstrated to reduce mortality by up to half compared with conventional incubator-based care. Uptake of KMC in low/middle-income countries has been limited, despite its suitability for low-resource environments. This paper reviews factors that contributed to the adoption and expansion of KMC in the Philippines. Early introduction began in 1999 but national scale-up was slow until 2014 after which a significant improvement in national adoption was observed. The proportion of target hospitals implementing KMC rose from 3% to 43% between 2014 and 2019, with 53% of preterm and low birthweight babies receiving KMC by the end of this period. Expansion was led by the government which committed resources and formed partnerships with development partners and non-governmental organisations. Scale-up of KMC was built on the introduction of evidence-based newborn care practices around birth. Practice changes were promoted and supported by consensus-based policy, protocol, regulatory and health insurance changes led by multidisciplinary teams. A new approach to changing and sustaining clinical practice used hospital teams to conduct on-the-job clinical coaching and use local data to make environmental changes to support practices. Institutionalisation of early skin-to-skin contact, non-separation of mother and newborn and early initiation of exclusive breast feeding, with increased responsibility given to mothers, drove a cultural change among staff and families which allowed greater acceptance and uptake of KMC. Financial and programmatic support must be sustained and expanded to address ongoing challenges including staffing gaps, available space for KMC, willingness of some staff to adopt new practices and lack of resources for clinical coaching and follow-up.
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Affiliation(s)
| | | | | | - John Charles Scott Murray
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Zhao Li
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Priya Mannava
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Jacqueline Kitong
- Maternal Child Health and Nutrition, World Health Organization, Country Office for Philippines, Manila, Philippines
| | - Mark Benjamin Quiazon
- Maternal Child Health and Nutrition, World Health Organization, Country Office for Philippines, Manila, Philippines
| | - Howard Lawrence Sobel
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
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Li Z, Mannava P, Murray JCS, Sobel HL, Jatobatu A, Calibo A, Tsevelmaa B, Saysanasongkham B, Ogaoga D, Waramin EJ, Mason EM, Obara H, Tran HT, Tuan HA, Kitong J, Yaipupu JM, Cheang K, Silvestre MA, Kounnavongsa O, Putney P, Nga PTQ, Tung R, Phal S, Kubota S, Krang S, Burggraaf S, Rattana S, Xu T, Zhang T, Enkhmaa U, Delgermaa V, Chhour YM. Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study. BMJ Glob Health 2021; 5:bmjgh-2020-002581. [PMID: 32764149 PMCID: PMC7412588 DOI: 10.1136/bmjgh-2020-002581] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/27/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes. Design Cross-sectional observational study. Setting 150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific. Participants 1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017. Main outcome measures Exclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation. Results Fifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose–response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30–59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60–89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF. Conclusion EENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.
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Affiliation(s)
- Zhao Li
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Priya Mannava
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - John Charles Scott Murray
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Howard Lawrence Sobel
- Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Annie Jatobatu
- Maternal and Child Health Division, Ministry of Health of Solomon Islands, Honiara, Solomon Islands
| | - Anthony Calibo
- Disease Prevention and Control Bureau, Department of Health, Manila, Philippines
| | - Baldan Tsevelmaa
- Department of Medical Service, Mongolia Ministry of Health, Ulaanbaatar, Mongolia
| | - Bounnack Saysanasongkham
- Department of Health Care and Rehabilitation, Ministry of Health, Lao People's Democratic Republic, Vientiane, Lao People's Democratic Republic
| | - Divinal Ogaoga
- Maternal and Child Health Division, Ministry of Health of Solomon Islands, Honiara, Solomon Islands
| | - Edward Joseph Waramin
- Department of Population and Family Health Services, Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea
| | - Elizabeth Mary Mason
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hiromi Obara
- Division of Global Health Policy and Research, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hoang Thi Tran
- Neonatal Department, Da Nang Hospital for Women and Children, Da Nang, Viet Nam
| | - Hoang Anh Tuan
- Department of Maternal and Child Health, Government of Viet Nam Ministry of Health, Hanoi, Viet Nam
| | - Jacqueline Kitong
- Department of Maternal Child Health and Nutrition, World Health Organization Country Office for Philippines, Manila, Philippines
| | - Jessica Mara Yaipupu
- Department of Maternal and Child Health, Office of the WHO Representative in Papua New Guinea, Port Moresby, Papua New Guinea
| | - Kannitha Cheang
- Department of Maternal and Child Health, WHO Representative Office Cambodia, Phnom Penh, Cambodia
| | | | - Outhevanh Kounnavongsa
- Department of Maternal and Child Health, Office of the WHO Representative in Laos PDR, Vientiane, Lao People's Democratic Republic
| | - Pamela Putney
- International Consultant, Martha's Vineyard, Massachusetts, USA
| | - Pham Thi Quynh Nga
- Department of Maternal and Child Health, Office of the WHO Representative in Viet Nam, Hanoi, Viet Nam
| | - Rathavy Tung
- National Maternal and Child Health Center, Royal Government of Cambodia Ministry of Health, Phnom Penh, Cambodia
| | - Sano Phal
- Department of Maternal and Child Health, WHO Representative Office Cambodia, Phnom Penh, Cambodia
| | - Shogo Kubota
- Department of Maternal and Child Health, Office of the WHO Representative in Laos PDR, Vientiane, Lao People's Democratic Republic
| | - Sidonn Krang
- Department of Communicable Diseases Control, Royal Government of Cambodia Ministry of Health, Phnom Penh, Cambodia
| | - Simon Burggraaf
- Department of Maternal and Child Health, Office of the WHO Representative in Solomon Islands, Honiara, Solomon Islands
| | - Sommana Rattana
- Department of Health Care and Rehabilitation, Ministry of Health, Lao People's Democratic Republic, Vientiane, Lao People's Democratic Republic
| | - Tao Xu
- National Center for Women and Children's Health, Child Health Care Department, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tuohong Zhang
- Department of Health Systems, Office of the WHO Representative in China, Beijing, China
| | - Ulziikhutag Enkhmaa
- Department of Medical Service, Mongolia Ministry of Health, Ulaanbaatar, Mongolia
| | - Vanya Delgermaa
- Department of Maternal and Child Health, Office of the WHO Representative in Mongolia, Ulaanbaatar, Mongolia
| | - Y Meng Chhour
- Under-Secretary of State for Health, Royal Government of Cambodia Ministry of Health, Phnom Penh, Cambodia
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Tran HT, Nguyen TT, Giang HTN, Huynh LT, Barnett D, Mathisen R, Murray JCS. Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam. Nutrients 2021; 13:nu13041151. [PMID: 33807207 PMCID: PMC8066195 DOI: 10.3390/nu13041151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Pasteurized donor milk (PDM) is typically prescribed to preterm or low birthweight newborns when their mother’s own milk is unavailable. In surplus, PDM is prescribed to meet the nutritional needs of healthy newborns in the first few days of life. However, its overuse can undermine efforts to promote and support breastfeeding, waste resources, and reduce the availability of PDM for at-risk newborns. We conducted this study to examine factors associated with the prescription and prolonged use (>48 h) of privately purchased PDM to healthy newborns. Methods: Prospective observational study of 2440 mothers of healthy, term, and normal birthweight newborns born at Da Nang Hospital for Women and Children between April and August 2019. In addition to the descriptive analysis, we performed multiple logistic regressions to examine factors associated with the prescription of PDM (n = 2440) and prolonged PDM use among those who used PDM (n = 566). Results: Twenty-three percent (566/2440) of healthy, term, and birthweight ≥2500 g newborns received PDM and were included in the study. The prevalence of PDM use was higher for cesarean births (OR: 2.05; 95% CI: 1.66, 2.55) and among male newborns (OR: 1.33; 95% CI: 1.09, 1.62), but lower for farmers or workers (vs. other jobs; OR: 0.71; 95% CI: 0.54, 0.93), family income <10 million VND (vs. ≥10 million VND; OR: 0.67; 95% CI: 0.55, 0.82), and duration of skin-to-skin ≥90 min (vs. <90 min; OR: 0.54; 95% CI: 0.39, 0.76). Prolonged PDM use (12.4% of 566 newborns who used PDM) was associated with the mother having a higher socioeconomic status job (professional, small trader or homemaker; OR: 4.00; 95% CI: 1.39, 12.5), being a first-time mother (OR: 3.39; 95% CI: 1.92, 6.01) or having a cesarean birth (OR: 2.09; 95% CI: 1.02, 4.28). Conclusions: The prescription and prolonged use of privately purchased PDM was associated with non-medical factors unrelated to the ability to breastfeed effectively. The findings suggest the need for improved breastfeeding communication, counseling and support skills for health staff, development, and application of strict criteria on PDM use for healthy newborns and better routine monitoring of PDM use over time.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
- Correspondence: ; Tel.: +84-903-543-115
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
| | - Hoang Thi Nam Giang
- International Cooperation and Scientific Research Office, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam;
| | - Le Thi Huynh
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
| | - Debbie Barnett
- Milk Bank Scotland, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK;
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
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11
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Sobel HL, Murray JCS, Mannava P, Mathai M, Silvestre MAA. A case for updating the WHO Safe Childbirth Checklist to improve newborn care: Experience from seven Asia and Pacific countries. Acta Paediatr 2021; 110:404-408. [PMID: 32892427 DOI: 10.1111/apa.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
The WHO Safe Childbirth Checklist (the SCC) is a clinical tool developed to help health workers follow evidence-based maternal and perinatal care practices at childbirth. Newborn delivery care practices at facilities in seven countries in East Asia and the Pacific were compared to practices checked by the SCC. The analysis found that the SCC does not incorporate several key evidence-based practices around birth demonstrated to prevent newborn morbidity or mortality, or harmful practices associated with increased risks. A revision of the standard SCC is needed to maximise its potential to improve newborn outcomes. This can be initiated under the coordinating umbrella of WHO, but must ensure that the realities of labour and childbirth practices in low- and middle-income countries are considered and addressed.
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Affiliation(s)
- Howard L. Sobel
- Maternal Child Health and Quality and Safety World Health Organization for the Western Pacific Manila Philippines
| | - John C. S. Murray
- Maternal Child Health and Quality and Safety World Health Organization for the Western Pacific Manila Philippines
| | - Priya Mannava
- Maternal Child Health and Quality and Safety World Health Organization for the Western Pacific Manila Philippines
| | - Matthews Mathai
- Department of International Public Health Liverpool School of Tropical Medicine Liverpool UK
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12
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Tosif S, Jatobatu A, Maepioh A, Gray A, Sobel H, Mannava P, Duke T. Healthcare worker knowledge and skills following coaching in WHO early essential newborn care program in the Solomon Islands: a prospective multi-site cohort study. BMC Pregnancy Childbirth 2020; 20:84. [PMID: 32033598 PMCID: PMC7007662 DOI: 10.1186/s12884-020-2739-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Newborn mortality in Oceania declined slower than other regions in the past 25 years. The World Health Organization (WHO) introduced the Early Essential Newborn Care program (EENC) in 2015 in Solomon Islands, a Small Island Developing State, to address high newborn mortality. We explored knowledge and skills retention among healthcare workers following EENC coaching. Methods Between March 2015 and December 2017, healthcare workers in five hospitals were assessed: pre- and post-clinical coaching and at a later evaluation. Standardised written and clinical skills assessments for breathing and non-breathing baby scenarios were used. Additionally, written surveys were completed during evaluation for feedback on the EENC experience. Results Fifty-three healthcare workers were included in the evaluation. Median time between initial coaching and evaluation was 21 months (IQR 18–26). Median written score increased from 44% at baseline to 89% post-coaching (p < 0.001), and was 61% at evaluation (p < 0.001). Skills assessment score was 20% at baseline and 95% post-coaching in the Breathing Baby scenario (p < 0.001). In the Non-Breathing Baby scenario, score was 63% at baseline and 86% post-coaching (p < 0.001). At evaluation, median score in the Breathing Baby scenario was 82% a reduction of 13% from post-coaching (p < 0.001) and 72% for the Non-Breathing Baby, a reduction of 14% post-coaching (p < 0.001). Nurse aides had least reduction in evaluation scores of − 2% for the Breathing Baby and midwives − 10% for the Non-Breathing Baby respectively from post-coaching to evaluation. Conclusions EENC coaching resulted in immediate improvements in knowledge and skills but declined over time. Healthcare workers who used the skills in regular practice had higher scores. Complementary quality improvement strategies are needed to sustain resuscitation skills following training over time. Trial registration Australia New Zealand Trial Registry, Retrospective Registration (12/2/2019), registration number ACTRN12619000201178.
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Affiliation(s)
- Shidan Tosif
- Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Anna Jatobatu
- National Newborn Health Coordinator, Reproductive and Child Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Anita Maepioh
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Amy Gray
- Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Howard Sobel
- Coordinator Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Priya Mannava
- Technical Officer, Surveillance, Information and Accountability, Reproductive, Maternal, Newborn, Child and Adolescent Health, World Health Organisation Regional Office for the Western Pacific, Manila, Philippines
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
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13
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Masuda C, Ferolin SK, Masuda K, Smith C, Matsui M. Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study. BMC Pregnancy Childbirth 2020; 20:78. [PMID: 32024504 PMCID: PMC7003416 DOI: 10.1186/s12884-020-2778-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Evidenced-based practice is a key component of quality care. However, studies in the Philippines have identified gaps between evidence and actual maternity practices. This study aims to describe the practice of evidence-based intrapartum care and its associated factors, as well as exploring the perceptions of healthcare providers in a tertiary hospital in the Philippines. Methods A mixed-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages, as well as semi-structured interviews and focus group discussions with care providers to determine their perceptions and reasoning behind decisions to perform episiotomy or fundal pressure. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal, and environmental factors. Qualitative data were parsed and categorised to identify themes related to the decision-making process. Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices were also observed, such as intramuscular or intravenous oxytocin use in the second stage (14%) and lack of foetal heart rate monitoring (57%). Of primiparae, 92% received episiotomy and 31% of all deliveries received fundal pressure. Factors associated with the implementation of episiotomy included primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage of more than 30 min (aOR 4.6), and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3), and assisted delivery (aOR 4.8). Healthcare providers believe that these practices can prevent laceration. The rate of obstetric anal sphincter injuries (OASIS) was 17%. Associated with OASIS were assisted delivery (aOR 6.0), baby weights of more than 3.5 kg (aOR 7.8), episiotomy (aOR 26.4), and fundal pressure (aOR 6.2). Conclusions Our study found that potentially harmful practices are still conducted that contribute to the occurrence of OASIS. The perception of these practices is divergent with current evidence, and empirical knowledge has more influence. To improve practices the scientific evidence and its underlying basis should be understood among providers.
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Affiliation(s)
- Chisato Masuda
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Shirley Kristine Ferolin
- Department of Obstetrics and Gynaecology, Southern Philippines Medical Centre, JP Laurel Avenue, Bajada, Davao City, 8000, The Philippines
| | - Ken Masuda
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Chris Smith
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT, UK
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.
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Tran HT, Mannava P, Murray JC, Nguyen PTT, Tuyen LTM, Hoang Anh T, Pham TQN, Nguyen Duc V, Sobel HL. Early Essential Newborn Care Is Associated With Reduced Adverse Neonatal Outcomes in a Tertiary Hospital in Da Nang, Viet Nam: A Pre- Post- Intervention Study. EClinicalMedicine 2018; 6:51-58. [PMID: 31193626 PMCID: PMC6537584 DOI: 10.1016/j.eclinm.2018.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To accelerate reductions in neonatal mortality, Viet Nam rolled out early essential newborn care (EENC) using clinical coaching, quality improvement assessments in hospitals, and updated protocols. Da Nang Hospital for Women and Children, a tertiary referral hospital in central Viet Nam, compared outcomes pre- and post-EENC introduction. METHODS Records of live births and NICU admissions were reviewed pre- (November 2013-October 2014) and post- (November 2014-October 2015) EENC implementation. Delivery room practices, NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics. FINDINGS A total of 13,201 live births were delivered pre- and 14,180 live births post-EENC introduction. Post-EENC, delivery practice scores, rates of early and prolonged skin-to-skin contact and early breastfeeding rose significantly. There was a significant reduction in risk of NICU admissions (relative risk [RR] 0.68; 95% confidence interval [CI] 0.64-0.71; p < 0.0001), hypothermia on NICU admission (RR 0.72; 95% CI 0.65-0.81, p < 0.0001) and sepsis (RR 0.28; 95% CI 0.23-0.35, p < 0.0001). Exclusive breastfeeding rates in NICU increased from 49% to 88% (p < 0.0001) and of kangaroo mother care (KMC) from 52% to 67% (p < 0.0001). Reduced formula use resulted in decreased monthly costs. INTERPRETATION EENC introduction, including staff coaching, quality improvement assessments and changes in hospital protocols and environments, were associated with improved clinical practices, reduced NICU admissions, admissions with hypothermia and sepsis and increased rates of exclusive breastfeeding and KMC in the NICU. FUNDING Data collection was funded by the World Health Organization Western Pacific Regional Office and Newborns Vietnam. OUTSTANDING QUESTIONS •What is the impact of the package of early essential newborn care interventions on newborn mortality?•What are the total direct and indirect cost savings of early essential newborn care implementation?•What is the cost effectiveness of kangaroo mother care for preterm and low birth weight babies?•What strategies can help reduce unnecessary cesarean sections in hospitals?
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Affiliation(s)
- Hoang Thi Tran
- Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam
- Corresponding author at: Neonatal Unit, Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam.
| | - Priya Mannava
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
| | - John C.S. Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
| | | | - Le Thi Mong Tuyen
- Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam
| | - Tuan Hoang Anh
- Ministry of Health of Viet Nam, 138A Giang Vo Street, Ha Noi, Viet Nam
| | - Thi Quynh Nga Pham
- World Health Organization Representative Office in Viet Nam, 304 Kim Ma Street, Ha Noi, Viet Nam
| | - Vinh Nguyen Duc
- Ministry of Health of Viet Nam, 138A Giang Vo Street, Ha Noi, Viet Nam
| | - Howard L. Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
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