Kresnawati Windhi, Froulina Liza, Syahrizal Bobby Marwal, Sinaga Nurlely Bethesda, Manuama Edit Oktavia, Rohsiswatmo Rinawati, Wandita Setya
Department of Child Health, RSPAD Gatot Soebroto, Jakara Pusat, Jakarta, Indonesia
Department of Child Health, Biak General Hospital, Biak, Papua, Indonesia.
BMJ Open Qual. 2025 Jan 6;14(1):e002862. doi: 10.1136/bmjoq-2024-002862.
The neonatal mortality rate in Papua Province of Indonesia is unacceptably high. To address the issue, the Ministry of Health and UNICEF Indonesia initiated a hospital mentoring programme from 2014 to 2016 to improve the quality of care and health workers' capacity to provide neonatal care. This study aimed to assess the impact of hospital mentoring on neonatal mortality.
The study was conducted at Biak District Hospital, Indonesia. The neonatal mortality was compared for three periods: preintervention (2011-2013), mentorship intervention phase (2014-2016) and postintervention (2017-2020). The mentoring programme is a combination of a direct-intensive-regular mentoring process and a scholarship programme for paediatricians. In the mentoring process, paediatricians, neonatal nurses and electromedical staff from national hospitals were sent to train the nurses on nursing management for sick neonates, clinical neonatal resuscitation, stabilisation and transportation. The neonatal mortality data were collected from birth registers, medical records, death case review reports and mentoring programme reports.
A significant decrease in the percentage of death cases before 24 hours of hospitalisation and death cases due to asphyxia was observed in the three periods. In the death cases from referrals, a significant decrease from 70% in the intervention period to 39.7% in the postintervention period was observed (p<0.05). The survival rate of neonates with body weights under 1500 g and 1500-2500 g was compared in the intervention and postintervention period, a significant increase from 21% to 58% and 55% to 94% was observed, respectively (p<0.05).
The direct-intensive-regular mentoring intervention programme was found to be effective in reducing neonatal mortality through quality improvement in low-resource district hospitals.
印度尼西亚巴布亚省的新生儿死亡率高得令人无法接受。为解决这一问题，印度尼西亚卫生部和联合国儿童基金会于2014年至2016年启动了一项医院指导计划，以提高护理质量和卫生工作者提供新生儿护理的能力。本研究旨在评估医院指导对新生儿死亡率的影响。
该研究在印度尼西亚比亚克地区医院进行。比较了三个时期的新生儿死亡率：干预前（2011 - 2013年）、指导干预阶段（2014 - 2016年）和干预后（2017 - 2020年）。指导计划是直接强化定期指导过程和儿科医生奖学金计划的结合。在指导过程中，来自国立医院的儿科医生、新生儿护士和电子医疗人员被派去培训护士进行患病新生儿的护理管理、临床新生儿复苏、稳定和转运。新生儿死亡率数据从出生登记册、病历、死亡病例审查报告和指导计划报告中收集。
在这三个时期，观察到住院24小时内死亡病例和窒息导致的死亡病例百分比显著下降。在转诊死亡病例中，观察到从干预期的70%显著下降到干预后期的39.7%（p<0.05）。比较了干预期和干预后期体重低于1500克和1500 - 2500克新生儿的存活率，分别观察到从21%显著提高到58%和从55%显著提高到94%（p<0.05）。
通过在资源匮乏的地区医院提高质量，发现直接强化定期指导干预计划在降低新生儿死亡率方面是有效的。
