Developing context-sensitive, comprehensive newborn care protocols: integrating technologies with clinical care pathways for level 2 newborn units in Kenya

BackgroundAn estimated 2.3 million neonates die worldwide each year (47% of under-five mortality), with 75% occurring during the first week of life. The burden is highest in sub-Saharan Africa (n/N = 27/1000 neonatal mortality rate) and largely results from preventable conditions, such as prematurity, birth asphyxia, and infections. The Newborn Essential Solutions and Technologies (NEST360) programme supports health systems in resource-constrained settings (RCSs) through appropriate technologies, training, data use, and mentorship to reduce preventable neonatal deaths. The NEST360 programme, in partnership with the Kenya Ministry of Health, both inspired and enabled the development of evidence-based comprehensive newborn care protocols (NBU-Protocols) and a dissemination training. This article documents the development of the protocols and lessons learned to inform scalable solutions for RCSs.MethodsThe NBU-Protocols and their dissemination programme were developed through a review of evidence on the care for small and sick newborns, followed by iterative feedback from stakeholders, including frontline health workers, academics, and researchers. The protocols were piloted and further revised following a national stakeholder workshop.ResultsThe NBU-Protocols comprise three chapters: clinical care pathways; standard operating procedures for NBU equipment; and step-by-step instructions for common clinical procedures performed in level 2 NBUs. The protocols were grounded in family-centred care and infection prevention and control principles. They were presented as e-protocols with hyperlinks, bookmarks, and cross-references to facilitate ease of use. The protocols dissemination programme, called Newborn ETAT+, was a three-pronged training approach taught by experts in the following groups: clinical care pathways by paediatricians; equipment parts and functions by biomedical engineers; and equipment use and care by NBU nurses. A third of the training was dedicated to interactive lectures, with the remainder focussed on demonstrations, simulations, clinical procedures on manikins, and hands-on experience with NBU equipment.ConclusionsThe NBU-Protocols and training model highlight the potential of context-specific, multidisciplinary strategies to improve collaboration and standardise care in NBUs in low- and middle-income countries (LMICs)

Human Milk Calorie Guide: A Novel Color-Based Tool to Estimate the Calorie Content of Human Milk for Preterm Infants

Fixed-dose fortification of human milk (HM) is insufficient to meet the nutrient requirements of preterm infants. Commercial human milk analyzers (HMA) to individually fortify HM are unavailable in most centers. We describe the development and validation of a bedside color-based tool called the ‘human milk calorie guide’(HMCG) for differentiating low-calorie HM using commercial HMA as the gold standard. Mothers of preterm babies (birth weight ≤ 1500 g or gestation ≤ 34 weeks) were enrolled. The final color tool had nine color shades arranged as three rows of three shades each (rows A, B, and C). We hypothesized that calorie values for HM samples would increase with increasing ‘yellowness’ predictably from row A to C. One hundred thirty-one mother’s own milk (MOM) and 136 donor human milk (DHM) samples (total n = 267) were color matched and analyzed for macronutrients. The HMCG tool performed best in DHM samples for predicting lower calories (<55 kcal/dL) (AUC 0.87 for category A DHM) with modest accuracy for >70 kcal/dL (AUC 0.77 for category C DHM). For MOM, its diagnostic performance was poor. The tool showed good inter-rater reliability (Krippendorff’s alpha = 0.80). The HMCG was reliable in predicting lower calorie ranges for DHM and has the potential for improving donor HM fortification practices

Comparable Pregnancy Outcomes for HIV-Uninfected and HIV-Infected Women on Antiretroviral Treatment in Kenya

Abstract Background The impact of human immunodeficiency virus (HIV) on pregnancy outcomes for women on antiretroviral therapy (ART) in sub-Saharan Africa remains unclear. Methods Pregnant women in Kenya were enrolled in the second trimester and followed up to delivery. We estimated effects of treated HIV with 3 pregnancy outcomes: loss, premature birth, and low birth weight and factors associated with HIV-positive status. Results Of 2113 participants, 311 (15%) were HIV infected and on ART. Ninety-one of 1762 (5%) experienced a pregnancy loss, 169/1725 (10%) a premature birth (&amp;lt;37 weeks), and 74/1317 (6%) had a low-birth-weight newborn (&amp;lt;2500 g). There was no evidence of associations between treated HIV infection and pregnancy loss (adjusted relative risk [aRR], 1.19; 95% confidence interval [CI], .65–2.16; P = .57), prematurity (aRR, 1.09; 95% CI, .70–1.70; P = .69), and low birth weight (aRR, 1.36; 95% CI, .77–2.40; P = .27). Factors associated with an HIV-positive status included older age, food insecurity, lower education level, higher parity, lower gestation at first antenatal clinic, anemia, and syphilis. Women who were overweight or underweight were less likely to be HIV infected compared to those with normal weight. Conclusions Currently treated HIV was not significantly associated with adverse pregnancy outcomes. HIV-infected women, however, had a higher prevalence of other factors associated with adverse pregnancy outcomes. </jats:sec

Additional file 1 of Prevalence of microcephaly and Zika virus infection in a pregnancy cohort in Kenya, 2017–2019

Additional file 1: Table S1. Comparison of some characteristics between participants who completed follow-up and thoselost to follow-up