Centre for Rural Health, George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa.
KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
BMC Pediatr. 2019 Jan 24;19(1):29. doi: 10.1186/s12887-019-1396-8.
Many newborn infants die from preventable causes in South Africa, often these deaths occur in district hospitals. A multipronged intervention aiming to improve quality of newborn care in district hospitals was implemented comprising training in clinical care for sick and small newborns, skills development for health managers, on-site mentoring, and hospital accreditation. We present the results of the project evaluation.
We conducted three sequential cross-sectional surveys in 39 participating district hospitals at baseline, midpoint and endpoint of the three-year intervention period. Data were collected by a trained midwife using a series of checklists including: availability of trained staff, drugs and equipment; newborn care practices; perinatal mortality audits; neonatal unit staff skills; quality of record keeping. A scoring system was developed for three domains: resources; care practices; resuscitation equipment, and a composite score that included all variables measured. Health worker (HW) knowledge was assessed at midpoint and endpoint.
The average score for resources increased from 13.5 at baseline to 22.6 at endpoint (maximum score 34), for care practices from 17.7 to 22.6 (maximum score 29), and for resuscitation equipment from 10.8 to 16.1 (maximum 25). Average composite score improved significantly from 42.0 at baseline to 55.7 at midpoint to 60.7 at endpoint (maximum score 88) (p = 0.0012). Among 39 participating hospitals, 38 achieved higher scores at endpoint compared to baseline. Knowledge was higher among HWs trained during the project at midpoint and endpoint. Gaps that remained included poor infrastructure, lack of resuscitation equipment in some areas, poor postnatal care and lack of a dedicated doctor.
This intervention achieved measurable improvements in many important elements contributing to newborn care. A scoring system was used to track progress, compare facilities' performance, and identify areas for improvement. Various methods were used to generate the quality of care score, including skills assessment and record reviews. However, measuring quality of clinical care and outcomes was challenging, and we were unable to determine whether the intervention improved clinical care and lead directly to improved outcomes for babies. In developing a future score for quality of care, a stronger focus should be placed on assessing clinical care and outcomes.
南非有许多新生儿因可预防的原因而死亡，这些死亡通常发生在地区医院。我们实施了一项多管齐下的干预措施，旨在提高地区医院新生儿护理的质量，该措施包括对患病和弱小新生儿的临床护理培训、卫生管理人员技能发展、现场指导和医院认证。我们展示了该项目评估的结果。
我们在三年干预期间的基线、中点和终点，在 39 家参与的地区医院进行了三次连续的横断面调查。一名经过培训的助产士使用一系列检查表收集数据，包括：是否有经过培训的工作人员、药物和设备；新生儿护理实践；围产期死亡率审核；新生儿病房工作人员技能；记录保存质量。为三个领域制定了评分系统：资源；护理实践；复苏设备，以及包括所有测量变量的综合评分。在中点和终点评估卫生工作者（HW）的知识。
资源的平均得分从基线时的 13.5 分增加到终点时的 22.6 分（最高 34 分），护理实践的平均得分从 17.7 分增加到 22.6 分（最高 29 分），复苏设备的平均得分从 10.8 分增加到 16.1 分（最高 25 分）。平均综合得分从基线时的 42.0 分显著提高到中点时的 55.7 分，再提高到终点时的 60.7 分（最高 88 分）（p=0.0012）。在 39 家参与的医院中，有 38 家在终点时的得分高于基线。在项目期间接受培训的 HW 的知识在中点和终点时更高。仍然存在的差距包括基础设施差、一些地区缺乏复苏设备、产后护理差和缺乏专门的医生。
这项干预措施在许多有助于新生儿护理的重要因素方面取得了可衡量的改善。评分系统用于跟踪进展、比较设施的绩效，并确定需要改进的领域。使用了各种方法来生成护理质量评分，包括技能评估和记录审查。然而，衡量临床护理质量和结果具有挑战性，我们无法确定干预措施是否改善了临床护理并直接导致婴儿的结果改善。在制定未来的护理质量评分时，应更加注重评估临床护理和结果。
