Mwalweni Chank, Chirwa Ellen Mbweza, Chimala Eveles Banda, Shaba Mirriam Window, Lowole Leone, Kasawala Lucia, Mwakhundi Christina Kalawa
Balaka District Hospital, P.O Box 138, Balaka, Malawi.
School of Maternal, Neonatal and Reproductive Health, Kamuzu University of Health Sciences, Private Bag 360, Blantyre 3, Chichiri, Malawi.
Matern Health Neonatol Perinatol. 2024 Nov 4;10(1):21. doi: 10.1186/s40748-024-00191-7.
Birth asphyxia remains one of the leading causes of neonatal deaths worldwide with a higher incidence in resource limited countries such as Malawi. At Balaka district hospital, Birth asphyxia is the primary cause of neonatal mortality accounting for 37.3% of the district's neonatal deaths. Although various quality improvement initiatives on birth asphyxia such as Helping Babies Breathe have been documented in Malawi, there is limited information on use of criterion-based audit (CBA) to enhance the care of neonates with birth asphyxia. Criterion-based audit is a systematic and critical analysis that seeks to improve quality of care by reviewing cases against an explicit criterion and using findings to modify practice as necessary. This study aimed to evaluate the effectiveness of CBA in improving the quality of neonatal birth asphyxia care at Balaka district hospital in Malawi.
A CBA on the care of asphyxiated neonates was conducted at Balaka district hospital in Malawi. The care practices were assessed through a retrospective review of 110 cases notes which were selected by systematic random sampling technique. The care practices were compared with locally established standards, by a multidisciplinary team, based on the Malawi guidelines on care of the infant and newborn and World Health Organization documents. The gaps in the current practice were identified, reasons discussed, and recommendations were made and implemented. A re-audit was conducted on 110 case notes, six months after the initial audit.
The re-audit showed significant improvements in most of the set criteria for quality care: Checking of vital signs (80% vs. 98.2%; p = 0.000), laboratory investigations done (0.9% vs. 74%; p = 0.000), thermal support (82.7% vs. 91.8%; p = 0.041), correct diagnosis (60% vs. 81%; p = 0.001), correct treatment (18.7% vs. 81%; p = 0.000), correct feeding (12.7% vs. 56.4%; p = 0.000), Clinical officers conducting ward rounds (0% vs. 72%; p = 0.000), and daily weight check (49.1% vs. 93%; p = 0.000). Additionally, neonatal death decreased from 11% in the initial audit to 5% in the re-audit.
Criterion-based audit is a low-cost tool that can significantly improve the care of neonates with birth asphyxia in resource-limited countries.
出生窒息仍然是全球新生儿死亡的主要原因之一，在马拉维等资源有限的国家发病率更高。在巴拉卡区医院，出生窒息是新生儿死亡的主要原因，占该地区新生儿死亡的37.3%。尽管马拉维已经记录了各种关于出生窒息的质量改进举措，如“帮助婴儿呼吸”，但关于使用基于标准的审核（CBA）来加强对出生窒息新生儿护理的信息有限。基于标准的审核是一种系统的批判性分析，旨在通过对照明确的标准审查病例并根据结果必要时修改实践来提高护理质量。本研究旨在评估CBA在提高马拉维巴拉卡区医院新生儿出生窒息护理质量方面的有效性。
在马拉维巴拉卡区医院对窒息新生儿的护理进行了CBA。通过系统随机抽样技术选择110份病例记录进行回顾性审查，以评估护理实践。由多学科团队根据马拉维婴儿和新生儿护理指南及世界卫生组织文件，将护理实践与当地制定的标准进行比较。确定当前实践中的差距，讨论原因，并提出并实施建议。在初次审核六个月后，对110份病例记录进行了重新审核。
重新审核显示，大多数设定的优质护理标准有显著改善：生命体征检查（80%对98.2%；p = 0.000）、实验室检查完成情况（0.9%对74%；p = 0.000）、保暖支持（82.7%对91.8%；p = 0.041）、正确诊断（60%对81%；p = 0.001）、正确治疗（18.7%对81%；p = 0.000）、正确喂养（12.7%对56.4%；p = 0.000）、临床医生查房（0%对72%；p = 0.000）以及每日体重检查（49.1%对93%；p = 0.000）。此外，新生儿死亡率从初次审核时的11%降至重新审核时的5%。
基于标准的审核是一种低成本工具，可显著改善资源有限国家出生窒息新生儿的护理。
