Impacto de reorganización de redes de atención y la notificación por TICs de mujeres con emergencia obstétrica, en la mortalidad materna en Morelos, México año 2014

Session: Technology to Improve Coverage and Quality of Maternal Newborn Care

Presenter: Rosa Maria del Carmen Nuñez Urquiza, Secretariat of Health of Mexico
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Impacto de la comunicación inmediata de toda mujer con morbilidad obstétrica grave, por WatsApp a las máximas autoridades y a todos los directivos de hospital, ambulancias y banco de sangre- en la disminución de mortalidad materna y neonatal en el Estado de Morelos, 2014, México.

Antecedente: En el Estado de Morelos se registran 33,000 nacimientos anuales y la cobertura de atención de parto en unidad médica es del 95%. Se presentaron anualmente desde el 2006  entre  27 y 17 muertes maternas. En el 2013 llegó una nueva administración. Diagnóstico situacional: En enero de 2013 se estableció un equipo de análisis situacional de la mortalidad materna. Se detecto que en un 40% de los casos las mujeres habían peregrinado de un hospital a otro hasta llegar a un hospital resolutivo, pero demasiado tarde. Se hizo el análisis de una muestra de casos con el método de Morbilidad Materna Aguda Severa MASS(OPS 2011).

Estrategia: Con participación de directivos de hospitales se estableció el “tramo de control” de cada hospital en la resolución de la emergencia obstétrica. En  julio del 2013 la Ministra de Salud del Estado convocó a una reunión a los directivos de hospitales públicos y representantes de asociación de hospitales privados, donde cada uno se comprometió a resolver la emergencia hasta su tramo de control con oportunidad. En octubre de 2013 se estableció la obligatoriedad de notificación inmediata  por whatsapp  de toda mujer con emergencia obstétrica. Este mensaje lo recibe la Ministra, y la máximas autoridades de las tres instituciones públicas y todos los directivos de hospital y se dio seguimiento puntual hasta la resolución de cada caso. La mortalidad materna entre diciembre de 2013 y diciembre de 2014 fue de 3 alcanzando la RMM más baja en todo el país (10/cien mil nvr) Se comparten lecciones aprendidas.

Implementation of bCPAP to Improve Neonatal Outcomes in Malawi: Interim Results

Session: Clinical Interventions for Newborn Health: Improving the Odds for Survival

Presenter: Rebecca Richards-Kortum, Rice 360° Institute for Global Health Technologies

Background: Over the past two years, low-cost bubble CPAP was implemented at 18 government district and central hospitals in Malawi to improve neonatal survival.

Methodology: Implementation was carried out in three phases: the first phase included 4 central and 4 district hospitals, the second phase included 10 district hospitals, and the ongoing third phase will include the remaining 10 district hospitals. At each hospital, staff in the maternity and nursery wards were trained to use bCPAP and bCPAP machines were installed with ancillary technology, such as an oxygen concentrator, suction machine, and all necessary consumables. In the months following implementation, demographic and outcome data were collected for all neonates treated with bCPAP and compared to rates observed in a previous pilot study to implement bCPAP at Queen Elizabeth Central Hospital (QECH) in Malawi.  Outcomes were stratified by demographic factors, including patient admission temperature, admission weight, and diagnosis.

Results: To date, 879 neonates weighing ≥ 1 kg have received bCPAP.  The survival rate for phase 1 hospitals was 48%, lower than the 71% survival rate observed in the initial pilot evaluation at QECH.  Median admission temperatures were significantly higher for non-hyperthermic infants who survived to discharge than for those who did not in the pilot (36 °C vs 35.2 °C, p=0.021) and phase 1 (35.5 °C vs 35 °C, p=0.002) studies.  Moreover, the prevalence of moderate and severe hypothermia on admission was higher in phase 1 (25%) than in the pilot study (0%). In response, training was strengthened to emphasize thermal care and additional equipment was provided to strengthen warming capacity.  To date, the survival rate for phase 2 hospitals is 55%.

Conclusions: Results suggest that admission hypothermia is a critical factor in patient survival on bCPAP.

Piloting an Approach for Identifying Very Small Newborns Born at Home and Incorporating Targeted Messages and Support

Session: Clinical Interventions for Newborn Health: Improving the Odds for Survival

Presenter: Chudamani Bhandari, Child Health Division, Department of Health Services, Ministry of Health and Population, Nepal
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Background:  The mortality associated with small babies is disproportionately high especially in low income countries, with more than 80% of neonatal deaths concentrated in Sub-Saharan Africa and South Asia. The fact that a significant proportion of these small babies could be saved with the application of simple, cost-effective behaviors has led to the development of an approach for community care of small babies.

Methodology:  Pregnant women are given a card measuring 6.9cm which, based on Nepal data, has optimal specificity and sensitivity for classifying babies above and below 2000gm birthweight. Women are instructed to use the card to check that their newborn’s foot at birth is longer than the card. If not, they are to call a toll-free number printed on the card, prompting a series of messages on provision of essential care for the small babies, including thermal regulation with skin-to-skin care, support for feeding practice including expression of breast milk and cup/spoon feeding if needed, and early recognition of danger signs and referral of the newborn. In the pilot districts, training has been provided to community health volunteers as the main vehicles for distributing cards. At the time of distribution, they also instruct the woman to call the CHW to the home if they have a very small newborn. The CHWs, in turn, provide reinforcement counseling and support during home visits.

Results: It’s expected that there will be improvements in behavioral practices associated with small babies in the community. It’s also expected that targeting of postnatal visits will reduce the burden placed on the health systems, ensuring that the most vulnerable populations are being reached with better outcomes.

Conclusion: This presentation will report on early findings of a 2-district pilot of this new approach. We will present on the intervention and on documented changes in practices and care-seeking.

Country-Level Implementation of ‘Helping Babies Breathe’ Newborn Resuscitation Program: The Experience of Tanzania

Session: Clinical Interventions for Newborn Health: Improving the Odds for Survival

Presenter: Georgina Msemo, Department of Family and Reproductive Health/International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health
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Background: In Tanzania, addressing birth asphyxia, a leading cause of newborn death, is a national priority and includes scale up of Helping Babies Breathe (HBB).

Methodology: HBB scale up – led and coordinated by the government with high-level commitment, ownership, stakeholder consensus, a country scale-up plan and technical and financial support  focuses on preparing competent providers, improving facility readiness and strengthening the routine health information system (HIS).

Results: Over 17,000 providers were trained and more than 3,300 health facilities across 16 regions were equipped with resuscitation devices, training manikins and job aids for low-dose high-frequency on-site trainings. After 1 year of implementation, the number of deliveries conducted by an HBB-trained providers increased from 0% to 58%.  However, lack of on-the-job support, continued practice after training and rotation of trained staff out of labor wards hampered retention of skills and programme impact. To address these challenges, the Government of Tanzania implemented a set of course correction activities including refinement of the HBB training curriculum, development of an on-the-job training and set up of SMS learning reminders system to maintain skills. Newborn resuscitation competencies were also included in the pre-service curriculum. The routine HIS was updated to include key HBB steps and the number of newborns resuscitated. As a result of these interventions, the proportion of deliveries attended by an HBB-trained provider increased to 82% by 2015.

Conclusions: Health systems strengthening is essential for successful scale up and should include support for logistics, routine HIS strengthening and policies for continuous professional development to retain and update clinical skills. A key next step in Tanzania is implementation of a clinical mentorship system and ongoing strengthening of the HIS to improve measurement of newborn health service delivery and outcomes.