4 research outputs found
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Performance of a Nonelectric Infant Warmer in Rwandan Health Centers.
Background. Neonatal hypothermia remains a challenge in resource-limited settings. Methods. We conducted a prospective mixed-methods cohort study in rural Rwandan health centers to assess the performance of an infant warmer we designed for low-resource settings. All hypothermic infants were eligible for enrollment. Outcomes. Safety: incidence of adverse reactions. Effectiveness: attainment of euthermia, rate of temperature rise. Feasibility: correct use of warmer, signs of wear. Interviews of caregivers and nurses. Findings. Of 102 encounters, there were no adverse reactions. Of 80 encounters for hypothermia when infants on warmer for ≥1 hour, 79 achieved euthermia; 73 in ≤2 hours. Of the 80 encounters, 64 had temperature rise ≥0.5°C/h. Of the 102 encounters, there were no instances of the warmer being prepared, used, or cleaned incorrectly. Five out of the 12 warmers exhibited wear. Interview participants were predominantly positive; some found time for readiness of warmer challenging. Interpretation. The warmer performed well. It is appropriate to study in larger scale
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Health, nutrition, and development of children born preterm and low birth weight in rural Rwanda: a cross-sectional study
Background: As care for preterm and low birth weight (LBW) infants improves in resource-limited settings, more infants are surviving the neonatal period. Preterm and (LBW) infants are at high-risk of nutritional and medical comorbidities, yet little is known about their developmental outcomes in low-income countries. This study evaluated the health, nutritional, and developmental status of preterm/LBW children at ages 1–3 years in Rwanda. Methods: Cross-sectional study of preterm/LBW infants discharged between October 2011 and October 2013 from a hospital neonatal unit in rural Rwanda. Gestational age and birth weight were gathered from hospital records to classify small for gestational age (SGA) at birth and prematurity. Children were located in the community for household assessments in November–December 2014. Caregivers reported demographics, health status, and child development using locally-adapted Ages and Stages Questionnaires (ASQ-3). Anthropometrics were measured. Bivariate associations with continuous ASQ-3 scores were conducted using Wilcoxon Rank Sum and Kruskal Wallis tests. Results: Of 158 eligible preterm/LBW children discharged from the neonatal unit, 86 (54.4%) were alive and located for follow-up. Median birth weight was 1650 grams, median gestational age was 33 weeks, and 50.5% were SGA at birth. At the time of household interviews, median age was 22.5 months, 46.5% of children had feeding difficulties and 39.5% reported signs of anemia. 78.3% of children were stunted and 8.8% wasted. 67.4% had abnormal developmental screening. Feeding difficulties (p = 0.008), anemia symptoms (p = 0.040), microcephaly (p = 0.004), stunting (p = 0.034), SGA (p = 0.023), very LBW (p = 0.043), lower caregiver education (p = 0.001), and more children in the household (p = 0.016) were associated with lower ASQ-3 scores. Conclusions: High levels of health, growth, and developmental abnormalities were seen in preterm/LBW children at age 1–3 years. As we achieve necessary gains in newborn survival in resource-limited settings, follow-up and early intervention services are critical for ensuring high-risk children reach their developmental potential. Electronic supplementary material The online version of this article doi: (10.1186/s12887-017-0946-1) contains supplementary material, which is available to authorized users
Scaling-up the All Babies Count programme to eliminate preventable neonatal deaths in Rwanda: experiences midway through implementation
Background: Rwanda has made significant reductions in child mortality; however, reductions in neonatal deaths have been slower. Despite near universal facility-based delivery, about half of neonatal deaths occur within 48 h of birth in health facilities. All Babies Count is an evidence-based 18-month change acceleration process that provides neonatal equipment and supplies, neonatal training and mentoring, and district-wide quarterly learning collaborative sessions to promote peer-to-peer learning and continuous quality improvement in interprofessional teams. The Rwanda Ministry of Health and Partners In Health are scaling-up All Babies Count to facilities in seven hospital catchment areas to improve quality of care and reduce neonatal mortality. This study describes the first year of implementation. Methods: A quality-improvement adviser provided support for All Babies Count implementation in each hospital catchment area through mentorship, training, and quality-improvement coaching. Four catchment areas launched in June and July, 2017 (phase 1) and three in October and November, 2017 (phase 2), covering 76 rural health facilities (seven hospitals and 69 health centres) located in the northern, southern, and western provinces of Rwanda. We used data from Rwanda health management information systems to monitor indicators of antenatal, intrapartum, postnatal, and inpatient neonatal care; process data were gathered from activity logs kept by quality-improvement advisers and surveys were completed at learning collaborative sessions. We used a χ2 test to measure performance differences between baseline (phase 1, April to June, 2017; phase 2, July to September, 2017) and the most recent quarter of All Babies Count implementation (April to June, 2018). Findings: The percentage of women who had their first antenatal care visit in the first trimester of pregnancy increased from 48% (4414/9141) to 60% (6296/10 486) (p<0·0001) and the proportion of women receiving first postnatal care consultation within 24 h increased from 85% (2862/3356) to 93% (3060/3282) (p<0·0001). The proportion of participants in the learning collaborative sessions who reported being “very or extremely confident” working in quality improvement rose from 54% before the sessions to 95% after the sessions (p<0·0001), with 89 quality improvement projects (69 in antenatal care, 10 intrapartum, three in postnatal care, and seven in neonatology) initiated after two learning collaborative sessions in phase 1 hospital catchment areas and one session in phase 2 catchment areas. Interpretation: Improved performance in measures targeted by All Babies Count was seen halfway through programme implementation, along with active quality-improvement activities and increased confidence in working with quality-improvement measures. These preliminary results show promise for the All Babies Count programme to improve care delivery and reduce neonatal mortality in diverse geographic areas of Rwanda. Funding: All Babies Count is funded by Saving Lives at Birth