Manual Newborn Primary Care Guidelines

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This is a compilation of the Obstetric Urgency/Emergency Guidelines, the Obstetric Prenatal Care Guidelines, and the Newborn Primary Care Guidelines.
Table of contents

• Integrating Infant Mental Health at Primary Health Care Level
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• Paediatric Clinical Practice Guidelines :: SA Health
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• Introduction

The postnatal interview Likert scale score was analyzed by estimating the proportion of response for each category. All analyses were performed using Stata version 14 StataCorp. Approval for the study was sought and obtained from the Puntland Ministry of Health and from the Save the Children ethics review committee, and a non-research determination was approved by The Centers for Disease Control and Prevention CDC.

Women who presented to the health center for delivery care were approached by the study team.

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Consent information was read to the women in the local language, and verbal consent was sought. Those who consented were included in the study. Personal identifiers collected to facilitate the postnatal follow-up visit were destroyed immediately after completion of the data collection process. Consent was also sought and obtained from health care providers who were working in the four health facilities and who were directly involved in the provision of maternal and newborn care.

Overall, pregnant women in labor presented at the health facilities during the study period of August—October Of those women, 48 Of the women approached for consent, Among the women enrolled, Eleven women declined and 58 women were lost to follow-up. One-fifth [ The majority [ Footnote 3 The majority [ Few [ The caseload at the four health facilities was similar, with 1—3 deliveries per h period.

Most [ The birth outcomes were mostly singleton spontaneous vaginal deliveries, with one twin birth and no assisted vaginal deliveries. Overall, there were In terms of newborn complications, 4. There were no maternal deaths. The first category of essential newborn care, thermal care, had two of three components - drying immediately after birth and delayed bathing - practiced nearly universally in all the health facilities with an overall proportion of Conversely, the third component of thermal care - skin-to-skin contact of newborns with their mother - was rare, with only 8.

There was significant variation between the facilities with a low of 1. There was no statistically significant variation in skin-to-skin contact by parity or gestational age of newborn.

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The second category of essential newborn care, breastfeeding, had There was no statistically significant difference in the initiation of early breastfeeding or support to breastfeeding by parity. For the third category of essential newborn care, hygienic practice, nearly all [ However, hand washing was only practiced by Readiness for newborn resuscitation, the fourth category of newborn care, was lacking; printed partograph forms were available in 3.

In routine care for newborns, Health education and information provided to mothers prior to discharge was poor: Out of the eligible women for postnatal home interviews, Of the women who were interviewed, less than half [ Of the women who reported receiving information on newborn care, Overall, of the women interviewed, Across the four health facilities, the majority of women were either happy or very happy in the cleanliness of the clinic [ Of the five women who responded unhappy or very unhappy, 2 were unhappy or very unhappy in more than one domain and 4 were unhappy with the care provided.

Regarding, where the mothers who responded unhappy or very unhappy received care, they were distributed in the three health facilities: 2 mothers delivered in health facility 1; 2 delivered in health facility 2; and 1 delivered in health facility 3. Overall, Our study, conducted in a protracted conflict setting of Bossaso, Somalia, found that while the majority of the childbirths were attended by skilled health workers midwives and nurses , the observed quality of care varied.

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The components of essential newborn care: thermal care, infection prevention, early initiation of breastfeeding, and readiness to provide newborn resuscitation, were not universally provided or available. Access to health care and a skilled health provider is always a concern in humanitarian emergencies.

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However, the quality of care found in our study was not optimal. Although the two thermal care components of immediate drying of newborn and delayed bathing were nearly universal for all newborns, skin-to-skin contact was not often practiced. This finding is consistent with studies from sub-Saharan Africa where immediate drying is commonly practiced by birth attendants, but not skin-to-skin contact [ 25 ]. Similarly, a study in South Sudan, a protracted crises situation, had lower proportions of women practicing skin-to-skin contact at the primary health facility level as compared to the hospital [ 26 ].

In our study, skin-to-skin contact was not emphasized on pre-discharge education to mothers and only one mother in the postnatal interview recalled receiving messaging on the importance of skin-to-skin contact. A systematic review by Moore and colleagues [ 30 ] showed that skin-to-skin contact when practiced, promoted breastfeeding and stabilization of the healthy term newborn.

The benefits of skin-to-skin contact for stability of the cardio-respiratory system and thermal control among low-birth-weight LBW and preterm infants have been reported by earlier studies [ 30 , 31 ], in our study, while 2. Overall, less than half Studies have shown that mothers are more likely to breastfeed if breastfeeding is initiated early and mothers receive support on how to breastfeed [ 31 ]. Though necessity of breastfeeding was the most prevalent observed message delivered to mothers prior to discharge Hygienic practices by health care workers during childbirth are vital to reduce health care-associated infections [ 33 ].

Nearly all births were attended by health care workers who wore clean or sterile gloves for examination and for attending births. However, handwashing with soap prior to delivery care was practiced by few health workers. The low prevalence of handwashing by health care workers may be due to low adherence to standard practices or low knowledge by service providers. In high neonatal mortality settings such as Somalia, the WHO recommends the application of chlorhexidine antiseptic gel or solution to the umbilical stump for infants born at home and dry cord care at health facility level [ 24 ].

In such settings, where hygienic practices are not adhered to, it may be beneficial to consider the use of chlorhexidine for cord care at the facility level. Studies on stillbirths have suggested that intrapartum-related stillbirths, may be preventable with improved intrapartum care with partograph use and early action to manage complications [ 16 ]. The lack of space in the labor room and maternity waiting area could have contributed to the short length of stay.

This short length of stay presents a challenge for health care workers in providing key information to mothers before discharge.

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In our study, few mothers were observed receiving messages on thermal care, cord care, feeding or danger signs and this low level of health messaging was also reflected in the home interviews. This is a missed opportunity, especially in contexts like Bossaso, where mothers may not return for postnatal check-ups and have few additional encounters with the healthcare system.

Most of the mothers interviewed as part of this study reported being happy or very happy with the services they received at the health center. This finding was consistent across the four health facilities and across the eight domains cleanliness, friendliness, respect, confidentiality, care provided, timeliness, received answer to questions, and privacy.

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This positive reporting from mothers is encouraging and is higher than in similar studies in sub-Saharan Africa [ 36 ]. However, among the five women who responded unhappy or very unhappy, two were unhappy across multiple domains and four out of five were unhappy with care provided. Future studies should follow this qualitative finding with in-depth interviews.

In situations where intrapartum care does not include early recognition of complications by using partographs and timely management of obstetric complications, it is difficult to distinguish deaths due to intrapartum complications from other causes [ 34 ].



Therefore, examining both stillbirths and early neonatal deaths is important in evaluating the effectiveness of interventions. Earlier studies on effectiveness of the WHO essential newborn training package have shown statistically significant reductions of early newborn deaths after service providers received the essential newborn training [ 32 , 37 ].

Training of the midwives and nurses in Bossaso on essential newborn care is crucial to improve quality of care and to decrease newborn mortality. Our study found significant variation by health facility in the practice of skin-to-skin contact, support in the initiation of breastfeeding, initiation of immediate breastfeeding, handwashing, and dry cord care.

Further study is needed to understand what factors contributed to these variations, as the data shows the percent of births attended by a skilled health worker was similar in all four health facilities. Identification of the specific reasons behind the variations will help target support given to facilities and health care workers in order to improve the consistency and quality of newborn care provision in these contexts. Essential newborn interventions are evidence-based lifesaving interventions and it is critical that these interventions are available at quality levels to improve newborn survival in conflict settings.

This study focused on the provision and quality of essential newborn care provided during labor, delivery and the immediate postnatal period. The findings provide critical baseline information on coverage and gaps of evidence-based newborn care interventions in humanitarian contexts.

Using observation of practice rather than clinical records provides greater data accuracy.

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Observing the delivery of information to mothers by health care providers and asking mothers about what information they recalled receiving approximately 1-week postnatal gives insight on whether key messages are delivered effectively. The study had several limitations. These women may have had different experiences of satisfaction, maternal knowledge, and newborn complications in the first week of life than those reported by the interviewed women.

It is possible that the childbirth satisfaction results underestimated dissatisfaction, as women may have responded positively due to social desirability bias. Additionally, women who were excluded from the interviews because of an adverse birth outcome stillbirth or early neonatal death may have had different levels of satisfaction in care.

Another limitation is that the presence of observers may have altered the behavior and practice of service providers [ 38 ]. The service providers were aware that their practice was being observed for research purposes and may have performed differently than if they were not observed. However, this effect could have been minimized by having observers from Bossaso who were not affiliated with the Ministry of Health and who were on a similar professional level as the observed service providers.

Finally, pregnant women with early signs of complications were referred to the hospital and were not enrolled in this study. It is possible that the findings of the study are an underestimation of maternal and newborn complications and adverse outcomes. In addition, as the health facilities were purposely selected for this study, our findings have limited generalizability. In conclusion, this study provides baseline information on essential newborn practice in selected health facilities in Bossaso, Somalia, a protracted conflict situation. Essential newborn care was not universally practiced and there was variation in practice by health facility.

Introduction

The implementation of the Field Guide [ 14 ] has the potential to improve newborn practice through the training of service providers and the delivery of newborn care education to mothers. This indicator was modified to measure delayed bathing up to time of discharge from health facility. Was released at the time of the study. Humanitarian Coalition: What is a humanitarian emergency? Lessons learned from complex emergencies over past decade. Countries in protracted crisis: what are they and why do they deserve special attention? Common features of countries in protracted crisis. The State of Food Insecurity in the World United Nations High Commissioner for Refugees.

Global trends: forced displacement in Accessed 16 Dec The public health aspects of complex emergencies and refugee situations. Ann Rev Pub Health. Child Health in Complex Emergencies. WHO Bull. Health-care needs of people affected by conflict: future trends and changing frameworks. Confronting stillbirths and newborn deaths in areas of conflict and political instability: a neglected global imperative. Pediatr In Child Health. Evidence on public health interventions in humanitarian crises.