Additional file 1 of Adaptation of Essential Care for Every Baby educational program to improve infant outcomes in the context of Zika

Additional file 1

Table_1_Perceptions and experiences of Congolese midwives implementing a low-cost battery-operated heart rate meter during newborn resuscitation.DOCX

Background900,000 newborns die from respiratory depression each year; nearly all of these deaths occur in low- and middle-income countries. Deaths from respiratory depression are reduced by evidence-based resuscitation. Electronic heart rate monitoring provides a sensitive indicator of the neonate's status to inform resuscitation care, but is infrequently used in low-resource settings. In a recent trial in the Democratic Republic of the Congo, midwives used a low-cost, battery-operated heart rate meter (NeoBeat) to continuously monitor heart rate during resuscitations. We explored midwives' perceptions of NeoBeat including its utility and barriers and facilitators to use.MethodsAfter a 20-month intervention in which midwives from three facilities used NeoBeat during resuscitations, we surveyed midwives and conducted focus group discussions (FGDs) regarding the incorporation of NeoBeat into clinical care. FGDs were conducted in Lingala, the native language, then transcribed and translated from Lingala to French to English. We analyzed data by: (1) coding of transcripts using Nvivo, (2) comparison of codes to identify patterns in the data, and (3) grouping of codes into categories by two independent reviewers, with final categories determined by consensus.ResultsEach midwife from Facility A used NeoBeat on an estimated 373 newborns, while each midwife at facilities B and C used NeoBeat an average 24 and 47 times, respectively. From FGDs with 30 midwives, we identified five main categories of perceptions and experiences regarding the use of NeoBeat: (1) Providers' initial skepticism evolved into pride and a belief that NeoBeat was essential to resuscitation care, (2) Providers viewed NeoBeat as enabling their resuscitation and increasing their capacity, (3) NeoBeat helped providers identify flaccid newborns as liveborn, leading to hope and the perception of saving of lives, (4) Challenges of use of NeoBeat included cleaning, charging, and insufficient quantity of devices, and (5) Providers desired to continue using the device and to expand its use beyond resuscitation and their own facilities.ConclusionMidwives perceived that NeoBeat enabled their resuscitation practices, including assisting them in identifying non-breathing newborns as liveborn. Increasing the quantity of devices per facility and developing systems to facilitate cleaning and charging may be critical for scale-up.</p

Serious and Life-Threatening Pregnancy-Related Infections: Opportunities to Reduce the Global Burden

Serious and Life-Threatening Pregnancy-Related Infections: Opportunities to Reduce the Global Burde

Pyelonephritis/urosepsis.

<p>HICs, high-income countries.</p

Literature review strategy.

<p>Relevant studies from the years 1980 to 2012 were identified by searching PubMed, Medline, Embase, and WHO publications. The search strategy used was “([infectious syndrome]) AND (Africa OR Asia OR India OR Thailand OR Bangladesh)”; the infectious syndromes included in our search were those that cause the most morbidity and mortality: puerperal sepsis (PPE, chorioamnionitis), septic abortion, pyelonephritis or urosepsis, and soft tissue infections (necrotizing fasciitis, group A streptococcal infection, and methicillin-resistant staphylococcal infection). All titles and abstracts were reviewed, and those including etiology, prevalence, or pregnancy were selected for further analysis.</p

Timing of four clinical syndromes and their pathogens, and potential opportunities for “bundled” diagnostic–therapeutic interventions.

<p>See <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001324#pmed-1001324-t002" target="_blank">Table 2</a> for further details of the interventions.</p

Septic abortion.

<p>HICs, high-income countries.</p

Common syndromes associated with life-threatening maternal infections and the pathogens most frequently associated with these.

<p>Common syndromes associated with life-threatening maternal infections and the pathogens most frequently associated with these.</p

Interventions for reducing serious morbidities and mortalities from pregnancy-related infections.

<p>pPROM, preterm premature rupture of membranes; PROM, premature rupture of membranes.</p