Ntigurirwa Placide, Mellor Kathy, Langer Daniel, Evans Mari, Robertson Emily, Tuyisenge Lisine, Groves Alan, Lissauer Tom
Muhima Hospital, Kigali, Rwanda.
BirthLink, Ickenham, UB10 8HN, UK.
Global Health. 2017 Jun 1;13(1):28. doi: 10.1186/s12992-017-0252-6.
A health partnership to improve hospital based neonatal care in Rwanda to reduce neonatal mortality was requested by the Rwandan Ministry of Health. Although many health system improvements have been made, there is a severe shortage of health professionals with neonatal training.
Following a needs assessment, a health partnership grant for 2 years was obtained. A team of volunteer neonatologists and paediatricians, neonatal nurses, lactation consultants and technicians with experience in Rwanda or low-income countries was assembled. A neonatal training program was provided in four hospitals (the 2 University hospitals and 2 district hospitals), which focused on nutrition, provision of basic respiratory support with nasal CPAP (Continuous Positive Airway Pressure), enhanced record keeping, thermoregulation, vital signs monitoring and infection control. To identify if care delivery improved, audits of nutritional support, CPAP use and its complications, and documentation in newly developed neonatal medical records were conducted. Mortality data of neonatal admissions was obtained.
Intensive neonatal training was provided on 27 short-term visits by 10 specialist health professionals. In addition, a paediatric doctor spent 3 months and two spent 6 months each providing training. A total of 472 training days was conducted in the neonatal units. For nutritional support, significant improvements were demonstrated in reduction in time to initiation of enteral feeds and to achieve full milk feeds, in reduction in maximum postnatal weight loss, but not in days for regaining birth weight. Respiratory support with bubble CPAP was applied to 365 infants in the first 18 months. There were no significant technical problems, but tissue damage, usually transient, to the nose and face was recorded in 13%. New medical records improved documentation by doctors, but nursing staff were reluctant to use them. Mortality for University teaching hospital admissions was reduced from 23.6% in the 18 months before the project to 21.7%. For the two district hospitals, mortality reduced from 10% to 8.1%. A major barrier to training and improved care was low number of nurses working on neonatal units and staff turnover.
This health partnership delivered an intensive program of capacity building by volunteer specialists. Improved care and documentation were demonstrated. CPAP was successfully introduced. Mortality was reduced. This format can be adapted for further training and improvement programs to improve the quality of facility-based care.
卢旺达卫生部请求建立一个卫生伙伴关系，以改善该国基于医院的新生儿护理，降低新生儿死亡率。尽管卫生系统已做出诸多改进，但经过新生儿护理培训的卫生专业人员仍严重短缺。
在进行需求评估后，获得了一笔为期两年的卫生伙伴关系赠款。组建了一支由志愿新生儿科医生、儿科医生、新生儿护士、哺乳顾问和在卢旺达或低收入国家有工作经验的技术人员组成的团队。在四家医院（两家大学医院和两家地区医院）开展了新生儿培训项目，重点内容包括营养、使用鼻持续气道正压通气（CPAP）提供基本呼吸支持、加强记录保存、体温调节、生命体征监测以及感染控制。为确定护理服务是否得到改善，对营养支持、CPAP使用及其并发症情况，以及新建立的新生儿病历中的记录进行了审核。获取了新生儿入院的死亡率数据。
10名专业卫生人员通过27次短期访问提供了强化新生儿培训。此外，一名儿科医生驻留3个月，两名各驻留6个月提供培训。新生儿病房共开展了472个培训日。在营养支持方面，在开始肠内喂养的时间、实现全奶喂养的时间、出生后最大体重减轻幅度方面有显著改善，但在恢复出生体重所需天数方面没有改善。在最初18个月里，365名婴儿接受了气泡式CPAP呼吸支持。未出现重大技术问题，但有13%的婴儿出现了通常为短暂性的鼻面部组织损伤。新病历改善了医生的记录，但护理人员不太愿意使用。大学教学医院入院新生儿的死亡率从项目前18个月的23.6%降至21.7%。两家地区医院的死亡率从10%降至8.1%。培训和改善护理的一个主要障碍是新生儿病房护士数量少以及人员流动率高。
这种卫生伙伴关系通过志愿专家开展了一项强化能力建设项目。护理和记录得到改善。成功引入了CPAP。死亡率降低。这种模式可适用于进一步的培训和改进项目，以提高机构护理质量。
