Browsing by Author "Moxon, S.G."
Now showing 1 - 5 of 5
Results Per Page
Sort Options
Item Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solution(BMC Pregnancy and Childbirth, 2015-09) Enweronu-Laryea, C.; Dickson, K.E.; Moxon, S.G.; Simen-Kapeu, A.; Nyange, C.; Niermeyer, S.; Bégin, F.; Sobel, H.L.; Lee, A.C.C.; von Xylander, S.R.; Lawn, J.E.Background: An estimated two-thirds of the world's 2.7 million newborn deaths could be prevented with quality care at birth and during the postnatal period. Basic Newborn Care (BNC) is part of the solution and includes hygienic birth and newborn care practices including cord care, thermal care, and early and exclusive breastfeeding. Timely provision of resuscitation if needed is also critical to newborn survival. This paper describes health system barriers to BNC and neonatal resuscitation and proposes solutions to scale up evidence-based strategies. Methods: The maternal and newborn bottleneck analysis tool was applied by 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" that hinder the scale up of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for BNC and neonatal resuscitation. Results: Eleven of the 12 countries provided grading data. Overall, bottlenecks were graded more severely for resuscitation. The most severely graded bottlenecks for BNC were health workforce (8 of 11 countries), health financing (9 out of 11) and service delivery (7 out of 9); and for neonatal resuscitation, workforce (9 out of 10), essential commodities (9 out of 10) and service delivery (8 out of 10). Country teams from Africa graded bottlenecks overall more severely. Improving workforce performance, availability of essential commodities, and well-integrated health service delivery were the key solutions proposed. Conclusions: BNC was perceived to have the least health system challenges among the seven maternal and newborn intervention packages assessed. Although neonatal resuscitation bottlenecks were graded more severe than for BNC, similarities particularly in the workforce and service delivery building blocks highlight the inextricable link between the two interventions and the need to equip birth attendants with requisite skills and commodities to assess and care for every newborn. Solutions highlighted by country teams include ensuring more investment to improve workforce performance and distribution, especially numbers of skilled birth attendants, incentives for placement in challenging settings, and skills-based training particularly for neonatal resuscitation. (PDF) Basic newborn care and neonatal resuscitation: A multi-country analysis of health system bottlenecks and potential solutions. Available from: https://www.researchgate.net/publication/281749399_Basic_newborn_care_and_neonatal_resuscitation_A_multi-country_analysis_of_health_system_bottlenecks_and_potential_solutions [accessed Sep 14 2018].Item Basic newborn care and neonatal resuscitation: A multi-country analysis of health system bottlenecks and potential solutions(BioMed Central Ltd., 2015) Enweronu-Laryea, C.; Dickson, K.E.; Moxon, S.G.; Simen-Kapeu, A.; Nyange, C.; Niermeyer, S.; Bégin, F.; Sobel, H.L.; Lee, A.C.C.; von Xylander, S.R.; Lawn, J.E.Item Count every newborn; A measurement improvement roadmap for coverage data(BioMed Central Ltd., 2015) Moxon, S.G.; Ruysen, H.; Kerber, K.J.; Amouzou, A.; Fournier, S.; Grove, J.; Moran, A.C.; Vaz, L.M.E.; Blencowe, H.; Conroy, N.; Gülmezoglu, A.M.; Vogel, J.P.; Rawlins, B.; Sayed, R.; Hill, K.; Vivio, D.; Qazi, S.A.; Sitrin, D.; Seale, A.C.; Wall, S.; Wall, S.; Jacobs, T.; Ruiz Peláez, J.G.; Guenther, T.; Coffey, P.S.; Dawson, P.; Marchant, T.; Waiswa, P.; Deorari, A.; Enweronu-Laryea, C.; Arifeen, S.E.; Lee, A.C.C.; Mathai, M.; Lawn, J.E.Background: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.Item Count every newborn; a measurement improvement roadmap for coverage data(BMC Pregnancy and Childbirth, 2015-09) Moxon, S.G.; Ruysen, H.; Kerber, K.J.; Amouzou, A.; Fournier, S.; Grove, J.; Moran, A.C.; Vaz, L.M.E.; Blencowe, H.; Conroy, N.; Gülmezoglu, A.M.; Vogel, J.P.; Rawlins, B.; Sayed, R.; Hill, K.; Vivio, D.; Qazi, S.A.; Sitrin, D.; Seale, A.C.; Wall, S.; Jacobs, T.; Ruiz Peláez, J.G.; Guenther, T.; Coffey, P.S.; Dawson, P.; Marchant, T.; Waiswa, P.; Deorari, A.; Enweronu-Laryea, C.; Arifeen, S.E.; Lee, A.C.C.; Mathai, M.; Lawn, J.E.BACKGROUND: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. METHODS: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. RESULTS: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. CONCLUSIONS: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.Item Service Readiness for Inpatient Care of Small and Sick Newborns: What Do We Need and What Can We Measure Now?(Journal of Global Health, 2018-06) Moxon, S.G.; Guenther, T.; Gabrysch, S.; Enweronu-Laryea, C.; Ram, P.K.; Niermeyer, S.; Kerber, K.; Tann, C.J.; Russel, N.l; Kak, L.; Bailey, P.; Wilson, S.; Wang, W.; Winter, R.; Carvajal-Aguirre, L.; Blencowe, H.; Campbell, O.; Lawn, J.Background: Each year an estimated 2.6 million newborns die, mainly from complications of prematurity, neonatal infections, and intrapartum events. Reducing these deaths requires high coverage of good quality care at birth, and inpatient care for small and sick newborns. In low- and middle-income countries, standardised measurement of the readiness of facilities to provide emergency obstetric care has improved tracking of readiness to provide care at birth in recent years. However, the focus has been mainly on obstetric care; service readiness for providing inpatient care of small and sick newborns is still not consistently measured or tracked. Methods: We reviewed existing international guidelines and resources to create a matrix of the structural characteristics (infrastructure, equipment, drugs, providers and guidelines) for service readiness to deliver a package of inpatient care interventions for small and sick newborns. To identify gaps in existing measurement systems, we reviewed three multi-country health facility survey tools (the Service Availability and Readiness Assessment, the Service Provision Assessment and the Emergency Obstetric and Newborn Care Assessment) against our service readiness matrix. Findings: For service readiness to provide inpatient care for small and sick newborns, our matrix detailed over 600 structural characteristics. Our review of the SPA, the SARA and the EmONC assessment tools identified several measurement omissions to capture information on key intervention areas, such as thermoregulation, feeding and respiratory support, treatment of specific complications (seizures, jaundice), and screening and follow up services, as well as specialised staff and service infrastructure. Conclusions: Our review delineates the required inputs to ensure readiness to provide inpatient care for small and sick newborns. Based on these findings, we detail where questions need to be added to existing tools and describe how measurement systems can be adapted to reflect small and sick newborns interventions. Such work can inform investments in health systems to end preventable newborn death and disability as part of the Every Newborn Action Plan.