Quality new born care a must for child survival
By Doreen Matonga
April 2016 - Sellina, 20 (not her real name) carried her pregnancy for 9 months with pride as she knew that a life was growing inside her. Being her first pregnancy, she looked forward to the day her child would be born. Mother Nature smiled on her in March this year and she delivered a healthy baby boy at Bwaila Hospital in Lilongwe.
Within hours of the baby’s birth, Sellina was home with her little bundle of joy. But in less than 7 days the joy she had turned into sadness as her baby boy developed a rash, which within a few days took away his life.
“My joy was cut short,” says Sellina. “I thought I would have someone to call my child. I endured the pain of child birth to be called a mother,” says Sellina as tears rolled down her cheeks.
And her loss was deeper because she was to carry the dead child on her back on their way back home for the burial. “I was told he had died. No one knows how the rash started. I never thought that would happen to me,” she says.
Sadly, the story of Sellina is just one of the many cases of new born death, which according to a Ministry of Health Situational Analysis of Newborn Health in Malawi report of 2013 contributes over 40% of all under 5 deaths in Malawi.
The case of Sellina is among the many where new-born deaths are neither investigated nor thoroughly audited, which affects the quality of care of newborns. Currently, most mothers are discharged within the first 12 to 24 hours of giving birth in Malawi.
A visit to Bwaila Hospital in Lilongwe, which on average delivers 1,000 babies every month, validated this is mostly due to bed space. The majority of cases that go beyond the 24 hour window are those delivered through caesarean section or babies born prematurely, or with low birth weight or jaundice.
In order to ensure an improvement in new-born care, UNICEF in partnership with WHO embarked on a project to improve the availability of high quality care through special neonatal care services in Thyolo, Zomba , Mangochi, Dedza, Bwaila, St Gabriel Mission, Kasungu District, Ekwendeni Mission and Mzuzu Central facilities in Malawi.
“We are working with the Paediatric and Child Health Association (PACHA) in partnership with the Reproductive Health Unit (RHU) in the Ministry of Health (MOH) to strengthen neonatal critical care in 10 hospitals in the country,” say Kyaw Aung, UNICEF Malawi Chief of Health.
“Most hospitals do not have neonatal units that can support quality care for babies to ensure that no death occurs within the first 28 days of life. Lack of information on the cause of maternal and newborn death impedes improvements in the quality of care. Conducting maternal and newborn mortality audits for all deaths within 2 weeks of birth will help us better understand the reasons why mothers and children die unnecessarily and ensure that health care workers learn and can improve care. This policy is there in Malawi, but it doesn’t happen, so we need to ensure DHO monitor and report on all death audits,” says Aung.
The short length of stay in hospital after childbirth means that mothers and babies miss out on postnatal care to detect, diagnose and treat complications.
“This is not ideal as some critical cases may be missed during this period. We are supporting the training and national rollout of post natal visits with trained health workers, who can spot if there are problems with newborns or mothers, and quickly refer them,” says Aung.
Although efforts have been made by various stakeholders to improve new born care, with an institutional delivery rate of 89%, indicators of quality care remain poor and too many new born babies and mothers are dying.
Health workers are often not trained or confident in caring for new born infants, especially those who are ill. To improve the quality, there is need to train key health staff and their supervisors in the special care practices known to work, such as case management of neonatal infection. For those that were trained in caring for new born infants, frequent rotation to other sections means that they cannot use their skills and knowledge to benefit patients and their infants.
Lack of quality improvement standards to analysze and improve the performance of facilities is another obstacle to enhancing health care outcomes. To improve quality standards, health staff skills should be aligned to the position and rotations should not become an impediment to quality care.
At the heart of quality new born care is a need for increased political will and commitment, as well as funding dedicated to promoting healthy babies and mothers. UNICEF advocates that countries provide universal access to quality health care, reduce out-of-pocket costs for patients, increase public health spending and investing in maternal and child health can significantly reduce neonatal mortality in the overall bracket of all under 5 deaths. With these things in place mothers like Sellina will not be left wondering how her baby died, and if she could have done anything to prevent it.
UNICEF and the Ministry of Health hosted a two day dissemination workshop on the findings of an assessment on the Quality of Care for mothers, neonates and children in Malawi. Sharing evidence, lessons learnt and best practices. The workshops aimed at orienting stakeholders on global quality of care policies, strategies, frameworks and standards, presenting and validating findings of the assessment done by Ministry of Health, UNICEF, WHO and the Liverpool School of Tropical Medicine but also to share evidence, lessons learned and best practices on quality of maternal and newborn care in Malawi.