坦桑尼亚姆特瓦拉地区医疗机构新生儿护理单元的可用性和功能：为小而患病的新生儿寻求住院护理质量。

Availability and functionality of neonatal care units in healthcare facilities in Mtwara region, Tanzania: The quest for quality of in-patient care for small and sick newborns.

机构信息

Department of Health Systems, Policy, Economic Evaluations, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania.

Department of Global Health and Bio-Medical Sciences (GHBM), School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania.

出版信息

PLoS One. 2022 Nov 21;17(11):e0269151. doi: 10.1371/journal.pone.0269151. eCollection 2022.

DOI:10.1371/journal.pone.0269151

PMID:36409741

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9678323/

Abstract

BACKGROUND

Evidence shows that delivery of prompt and appropriate in-patient newborn care (IPNC) through health facility (HF)-based neonatal care and stabilization units (NCU/NSUs) reduce preventable newborn mortalities (NMs). This study investigated the HFs for availability and performance of NCU/NSUs in providing quality IPNC, and explored factors influencing the observed performance outcomes in Mtwara region, Tanzania.

METHODS

A cross-sectional study was conducted using a follow-up explanatory mixed-methods approach. HF-based records and characteristics allowing for delivery of quality IPNC were reviewed first to establish the overall HF performance. The review findings were clarified by healthcare staff and managers through in-depth interviews (IDIs) and focus group discussions (FGDs).

RESULTS

About 70.6% (12/17) of surveyed HFs had at least one NCU/NSU room dedicated for delivery of IPNC but none had a fully established NCUs/NSU, and 74.7% (3,600/4,819) of needy newborns were admitted/transferred in for management. Essential medicines such as tetracycline eye ointment were unavailable in 75% (3/4) of the district hospitals (DHs). A disparity existed between the availability and functioning of equipment including infant radiant warmers (92% vs 73%). Governance, support from implementing patterns (IPs), and access to healthcare commodities were identified from qualitative inquiries as factors influencing the establishment and running of NCUs/NSUs at the HFs in Mtwara region, Tanzania.

CONCLUSION

Despite the positive progress, the establishment and performance of NCUs/NSUs in providing quality IPNC in HFs in Mtwara region is lagging behind the Tanzania neonatal care guideline requirements, particularly after the IPs of newborn health interventions completed their terms in 2016. This study suggests additional improvement plans for Mtwara region and other comparable settings to optimize the provision of quality IPNC and lower avoidable NMs.

摘要

背景

有证据表明，通过医疗机构（HF）为基础的新生儿护理和稳定单位（NCU/NSU）提供及时和适当的住院新生儿护理（IPNC），可以降低可预防的新生儿死亡率（NMs）。本研究调查了 HF 提供高质量 IPNC 的 NCU/NSU 的可用性和性能，并探讨了影响坦桑尼亚姆特瓦拉地区观察到的绩效结果的因素。

方法

使用后续解释性混合方法进行了一项横断面研究。首先审查了基于 HF 的记录和特征，以确定 HF 的整体性能，这些记录和特征允许提供高质量的 IPNC。通过医护人员和管理人员的深入访谈（IDIs）和焦点小组讨论（FGDs），澄清了审查结果。

结果

在接受调查的 17 家 HF 中，约 70.6%（12/17）至少有一个 NCU/NSU 房间专门用于提供 IPNC，但没有一个完全建立的 NCUs/NSU，74.7%（3600/4819）有需要的新生儿入院/转院进行管理。在 75%（3/4）的地区医院（DHs）中，四环素眼膏等基本药物都不可用。从定性调查中发现，设备的可用性和功能之间存在差异，包括婴儿辐射保暖器（92%对 73%）。治理、实施模式（IPs）的支持以及医疗保健商品的获取是从定性调查中确定的影响坦桑尼亚姆特瓦拉地区 HF 中 NCUs/NSUs 建立和运行的因素。

结论

尽管取得了积极的进展，但姆特瓦拉地区 HF 中 NCUs/NSUs 在提供高质量 IPNC 方面的建立和运行仍落后于坦桑尼亚新生儿保健指南的要求，特别是在新生儿保健干预措施的 IPs 于 2016 年结束后。本研究建议姆特瓦拉地区和其他类似环境制定额外的改进计划，以优化高质量 IPNC 的提供，并降低可避免的 NMs。