Neonatal Care in Mangochi District Hospital, Malawi

Abstract

Introduction: In 2018, globally 18 infants out of 1,000 live births died in their first 28 days of life, the neonatal period. Neonatal mortality has reduced substantially during the last decades, as it was 33 deaths per 1,000 live births in 1990. However, 99% of neonatal deaths take place in low- and middle-income countries. Neonatal deaths are predominantly due to preterm birth and intra-partum complications, 80% happen during the first week of life. One of the United Nations Sustainable Development Goals is to reduce neonatal mortality to at least 12 per 1,000 live births, by the year 2030. Current trends suggest that over 60 countries will miss this target. This study aims to identify some key problems in neonatal care and how the services can be improved in a hospital in a sub-Saharan country.Methods: Data were collected at the nursery department of Mangochi District Hospital in Malawi, where a new maternity wing, along with a nursery, opened in January 31, 2019. Study group I included information on admission, diagnosis and outcome of all neonates, admitted in the nursery registry book during the period July 1, 2018 to December 31, 2019. Comparison of admission rate was made between the Old and the New nursery, using a binomial test and the survival rate was compared by using a chi-square test. The number of admissions in Study group I were 2,368. Study group II included information on admission, diagnosis, treatment and outcome of all neonates admitted in the nursery in the period February 20, 2020 to March 11, 2020. Study group II consisted of 149 neonates. Furthermore, interviews were conducted with four health care providers working at the nursery, during the period, March 12-14, 2020.Results: In Study group I, there were 625 newborn admissions at the Old nursery and 1,743 at the New nursery. There were missing values for all variables, but most for gestational week, length of stay and outcome (40-80%), and usually higher in the Old nursery. Survival rate increased significantly in the New nursery, compared to the Old one (82.9% vs. 87.6%, p=0.0039). There was also a significant change in average monthly admissions, where admissions more than doubled (86.4 vs. 177.4, p<0.001). In Study group II, more than two-thirds were admitted during their first day of life. Birth asphyxia was the most common condition, diagnosed in almost half of the neonates. More than 20% died in the nursery. In interviews with the staff, shortage of staff and heavy workload were mentioned as main challenges at the workplace. Further, improvement in monitoring of infants and management of data at the New nursery compared to the Old one, was reported.Conclusion: Survival of neonates improved significantly, demonstrating improvements in the neonatal care by inauguration of a New nursery. Despite a decrease of missing data in the New nursery compared to the Old one, lack of registration and storage of data is still a major problem. Increase in admissions following the inauguration of the New nursery indicates that more women seek hospital service in MDH at delivery. Yet, for quality improvement, the health workforce gap must be addressed, coupled with improved monitoring of sick neonates and appropriate equipment and drugs, for further success towards the fulfillment of the Sustainable Developmental Goals.