Browsing by Author "Niermeyer, S."
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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 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.