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Ogola M, Njuguna EM, Aluvaala J, English M, Irimu G. Audit identified modifiable factors in Hospital Care of Newborns in low-middle income countries: a scoping review. BMC Pediatr 2022; 22:99. [PMID: 35180843 PMCID: PMC8855576 DOI: 10.1186/s12887-021-02965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/19/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Audit of facility-based care provided to small and sick newborns is a quality improvement initiative that helps to identify the modifiable gaps in newborn care (BMC Pregnancy Childbirth 14: 280, 2014). The aim of this work was to identify literature on modifiable factors in the care of newborns in the newborn units in health facilities in low-middle-income countries (LMICs). We also set out to design a measure of the quality of the perinatal and newborn audit process. METHODS The scoping review was conducted using the methodology outlined by Arksey and O'Malley and refined by Levac et al, (Implement Sci 5:1-9, 2010). We reported our results using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. We identified seven factors to ensure a successful audit process based on World Health Organisation (WHO) recommendations which we subsequently used to develop a quality of audit process score. DATA SOURCES We conducted a structured search using PubMed, CINAHL, EMBASE, LILACS, POPLINE and African Index Medicus. STUDY SELECTION Studies published in English between 1965 and December 2019 focusing on the identification of modifiable factors through clinical or mortality audits in newborn care in health facilities from LMICs. DATA EXTRACTION We extracted data on the study characteristics, modifiable factors and quality of audit process indicators. RESULTS A total of six articles met the inclusion criteria. Of these, four were mortality audit studies and two were clinical audit studies that we used to assess the quality of the audit process. None of the studies were well conducted, two were moderately well conducted, and four were poorly conducted. The modifiable factors were divided into three time periods along the continuum of newborn care. The period of newborn unit care had the highest number of modifiable factors, and in each period, the health worker related modifiable factors were the most dominant. CONCLUSION Based on the significant number of modifiable factors in the newborn unit, a neonatal audit tool is essential to act as a structured guide for auditing newborn unit care in LMICs. The quality of audit process guide is a useful method of ensuring high quality audits in health facilities.
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Affiliation(s)
- Muthoni Ogola
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, 197 Lenana Place, Lenana Road, P. O. Box 43640, Nairobi, 00100, Kenya.
- Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
- Pumwani Maternity Hospital, Nairobi, Kenya.
| | | | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, 197 Lenana Place, Lenana Road, P. O. Box 43640, Nairobi, 00100, Kenya
- Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, 197 Lenana Place, Lenana Road, P. O. Box 43640, Nairobi, 00100, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Grace Irimu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, 197 Lenana Place, Lenana Road, P. O. Box 43640, Nairobi, 00100, Kenya
- Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Gallagher K, Partridge C, Tran HT, Lubran S, Macrae D. Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study. BMC Pediatr 2017; 17:161. [PMID: 28697746 PMCID: PMC5505145 DOI: 10.1186/s12887-017-0909-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience. METHOD Semi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14. RESULTS Analysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience. CONCLUSIONS Qualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge and competence, and the impact and needs of parents. A greater understanding will allow us to continue to improve the experiences of nurses and parents, and highlight how these areas may contribute towards the reduction of infant mortality and morbidity in Vietnam.
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Affiliation(s)
- Katie Gallagher
- Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Colin Partridge
- Department of Pediatrics, University of California, San Francisco, USA
| | - Hoang T Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | | | - Duncan Macrae
- Pediatric Intensive Care, Royal Brompton and Harefield NHS Trust, London, UK
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Miles M, Dung KTK, Ha LT, Liem NT, Ha K, Hunt RW, Mulholland K, Morgan C, Russell FM. The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period. PLoS One 2017; 12:e0173407. [PMID: 28282433 PMCID: PMC5345801 DOI: 10.1371/journal.pone.0173407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/19/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To describe the cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam. Design A prospective hospital based observational study. Setting The Neonatal Department, National Hospital of Pediatrics, Hanoi, Vietnam. Patients All admissions to the Neonatal Department over a 12 month period. Main outcome measures Cause-specific morbidity and mortality; deaths. Results There were 5064 admissions with the commonest discharge diagnoses being infection (32%) and prematurity (29%). The case fatality ratio (CFR) was 13.9% (n = 703). Infection (38%), cardio/respiratory disorders (27%), congenital abnormalities (20%) and neurological conditions (10%) were the main causes of death. Of all the deaths, 38% had an admission weight ≥2500g. Higher CFR were associated with lower admission weights. Very few deaths (3%) occurred in the first 24 hours of life. Most referrals and deaths came from Hanoi and neighbouring provincial hospitals, with few from the most distant provinces. Two distant referral provinces had the highest CFR. Conclusions The CFR was high and few deaths occurred in neonates <24 hours old. The high rates of infection call for an improvement in infection control practices and peripartum antibiotic use at provincial and tertiary level. Understanding provincial hospital capacity and referral pathways is crucial to improving the outcomes at tertiary centres. A quality of care audit tool would enable more targeted interventions and monitoring of health outcomes.
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Affiliation(s)
- Merinda Miles
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | - Le Thi Ha
- National Hospital of Pediatrics, Hanoi, Vietnam
| | | | - Khu Ha
- National Hospital of Pediatrics, Hanoi, Vietnam
| | - Rod W. Hunt
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Department of Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Australia
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Kim Mulholland
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Menzies School of Health Research, Darwin, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Morgan
- Centre for International Health, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fiona M. Russell
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
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Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, Frøen JF, Gardosi J, Gordijn S, Gülmezoglu AM, Heazell AEP, Korteweg F, Lawn J, McClure EM, Pattinson R, Smith GCS, Tunçalp Ӧ, Wojcieszek AM, Flenady V. Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system. BMC Pregnancy Childbirth 2016; 16:269. [PMID: 27634615 PMCID: PMC5025539 DOI: 10.1186/s12884-016-1040-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 08/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system. Methods Eighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic. Results None of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %). Conclusions There is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with “ease of use” among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1040-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia. .,International Stillbirth Alliance, Millburn, USA.
| | - Zheyi Teoh
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Hanna Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.,International Stillbirth Alliance, Millburn, USA
| | - Emma Allanson
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
| | | | - Jan Jaap Erwich
- International Stillbirth Alliance, Millburn, USA.,University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
| | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.,Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | | | - Sanne Gordijn
- International Stillbirth Alliance, Millburn, USA.,University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Alexander E P Heazell
- International Stillbirth Alliance, Millburn, USA.,Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Fleurisca Korteweg
- International Stillbirth Alliance, Millburn, USA.,Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Millburn, USA.,Research Triangle Institute, North Carolina, USA
| | - Robert Pattinson
- South Africa Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
| | - Gordon C S Smith
- NIHR Biomedical Research Centre & Department of Obstetrics & Gynaecology, Cambridge University, Cambridge, UK
| | - Ӧzge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.,International Stillbirth Alliance, Millburn, USA
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia.,International Stillbirth Alliance, Millburn, USA
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Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam. J Perinatol 2015; 35:846-51. [PMID: 26156065 DOI: 10.1038/jp.2015.78] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/16/2015] [Accepted: 05/29/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to determine the prevalence, causes and outcome of sepsis in hospitalized neonates in the largest neonatal unit in central Vietnam. STUDY DESIGN A 1-year prospective cohort study of newborns admitted to the neonatal unit in Da Nang. A sepsis work-up including blood culture was undertaken before commencing antibiotics for neonates with suspected sepsis. RESULT Of 2555 neonatal admissions, 616 neonates had 729 episodes of suspected invasive sepsis. A pathogen was isolated from blood in 115 (16%) episodes in 106 neonates. The prevalence of early-onset sepsis (EOS) was 8 (95% confidence interval (CI): 4 to 11) per 1000 admissions, and of late-onset sepsis (LOS) was 34 (95% CI: 27 to 41) per 1000 admissions. Of 86 neonates with LOS, 69 (80%) also fulfilled the criteria for nosocomial sepsis. The commonest bacterial causes of EOS were coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus, and of LOS were Acinetobacter, CoNS and Klebsiella pneumoniae. Fungal sepsis occurred in 35 neonates of which most were nosocomial sepsis. In vitro resistance to multiple antibiotics was common among Gram-negative bacteria. Antibiotics were prescribed and given to 68% of all admissions, and 14% of all admissions received four or more different antibiotics. The case fatality rate for confirmed sepsis was 46%. CONCLUSION Late-onset, nosocomial sepsis was common and associated with a high mortality in hospitalized newborns in the largest neonatal unit in central Vietnam. These findings highlighted the need for improved infection control measures and antibiotic stewardship, which have since been implemented.
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Affiliation(s)
- H T Tran
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam.,Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - L W Doyle
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - K J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - N M Dang
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. Morbidity and mortality in hospitalised neonates in central Vietnam. Acta Paediatr 2015; 104:e200-5. [PMID: 25649520 DOI: 10.1111/apa.12960] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
Abstract
AIM This study explored neonatal morbidity and mortality in hospitalised patients in central Vietnam and risk factors associated with mortality. METHODS We conducted a prospective cohort study of all newborn infants (<28 days) hospitalised in a neonatal unit over a 1-year period and followed until discharge. The main outcome measures were case fatality rate and the rate of different clinical diagnoses. RESULTS There were 2555 admissions during the study period. The leading primary causes of admissions were infections (41%), haematological problems such as jaundice (23%) and prematurity and its complications (18%). The overall case fatality rate was 8.6%, and it was 59% among very low-birthweight (<1500 g) neonates. Mortality was inversely associated with birthweight and gestational age. Of the 220 deaths, 57% occurred within the first 7 days of life. Although the causes of death were often multifactorial, the leading primary causes were infections (32%), prematurity and its complications (25%), birth defects (24%) and birth asphyxia (6%). Risk factors associated with death were being outborn, early gestational age, small for gestational age, confirmed sepsis and birth defects. CONCLUSION Mortality rates were high among hospitalised neonates in central Vietnam, and this paper suggests interventions that might improve outcomes.
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Affiliation(s)
- Hoang T. Tran
- Neonatal Unit; Department of Paediatrics; Da Nang Hospital for Women and Children; Da Nang Vietnam
- Centre for International Child Health; University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
| | - Lex W. Doyle
- University of Melbourne Department of Obstetrics and Gynaecology; Royal Women's Hospital; Melbourne Vic. Australia
- Clinical Epidemiology and Biostatistics Unit; Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
| | - Katherine J. Lee
- Clinical Epidemiology and Biostatistics Unit; Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
| | - Na M. Dang
- Neonatal Unit; Department of Paediatrics; Da Nang Hospital for Women and Children; Da Nang Vietnam
| | - Stephen M. Graham
- Centre for International Child Health; University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
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