Title: Reductions in neonatal mortality in a mission hospital in Malawi
1Reductions in neonatal mortality in a mission
hospital in Malawi
2Geography
Population 60,496,000 Population12,884,000 (111.
2 per sq km) (108.7 per sq km)
3Significance
- Millennium Development Goal No 4
- Reduce by two thirds the mortality rate among
children under five
4Some Indicators
5Some Indicators
Sources WHO Statistical information System
(WHOSIS) Ministry of Health Malawi
6Nkhoma, some facts
- Mission hospital, 220 bed
- Deliveries 2,113 (2007)
- Rural population, catchment 60,850
- Referral centre for 12 clinics from 5 of these,
patients receive free maternal and neonatal care
7Result
- Reduction of hospital neonatal mortality from
3.8 to 1.6
8Intervention strategy (1)
- PDSA approach (Shewart, Deming cycle)
- In various areas simultaneously
9Intervention strategy (2)
- Reduction cross contamination
- Active case finding
- Protocol led treatment
- Delay reduction by empowerment
- Skills improvement
- Equipment
10Case finding
This neonatal sepsis protocol should be followed
if any of the following is present Temp over
37.5 or less than 36 axillary, respirations gt60
or lt20, grunting, or disseminated pustular
rash.
11Reduce delay
Nurse midwife assesses the patient immediately
and notifies clinician
Give 1st dose antibiotics Ampicilline 50mg/kg
50 x _____ _____mg Time______
Sign Gentamycin 5mg/kg 5 x _____ _____mg
Time______ Sign
12Protocol led treatment
- Plans Check (?) all that apply.
- Give antibiotics for 7-14 days if signs of
sepsis - ? If hypoglycaemia
- ? If respiratory distress,
- ? If Pain or
- ? If Convulsing
13Result - review
14Challenges / Sustainability
- Availability of basics, e.g. paper
- Stationary as important as antibiotics
- Enthusiasm of staff
- Repeated reinforcement necessary
- Dependency on individuals
- Ward in-charge to be fully involved
15Conclusion
- As shown, a breakthrough change is possible,
despite limited resources. - Sustainability, however, depends largely on a
continued effort from those directly involved on
the site of intervention.
16Thank You