A health partnership to reduce neonatal mortality in four hospitals in Rwanda.
A health partnership to reduce neonatal mortality in four hospitals in Rwanda.
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DOI：
10.1186/s12992-017-0252-6
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发表时间：
2017-06-01
影响因子：
10.8
通讯作者：
Lissauer T
中科院分区：
文献类型：
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作者：
Ntigurirwa P;Mellor K;Langer D;Evans M;Robertson E;Tuyisenge L;Groves A;Lissauer T
卢旺达卫生部要求建立卫生伙伴关系，以改善卢旺达医院的新生儿护理，降低新生儿死亡率。尽管卫生系统已取得许多改进，但受过新生儿培训的卫生专业人员严重短缺。在进行需求评估后，获得了为期两年的卫生伙伴关系赠款。组建了一个由在卢旺达或低收入国家有经验的志愿产科医生和儿科医生、新生儿护士、哺乳顾问和技术人员组成的小组。在四家医院（2家大学医院和2家地区医院）提供新生儿培训方案，重点是营养、通过鼻CPAP（持续气道正压通气）提供基本呼吸支持、加强记录保存、体温调节、生命体征监测和感染控制。为了确定护理服务是否得到改善，对营养支持、CPAP使用及其并发症以及新开发的新生儿病历中的文件进行了审计。获得新生儿入院的死亡率数据。10名专业保健人员在27次短期访问中提供了新生儿强化培训。此外，一名儿科医生接受了3个月的培训，两名儿科医生接受了6个月的培训。在新生儿病房共进行了472个培训日。对于营养支持，在缩短开始肠内喂养和实现全奶喂养的时间、减少最大产后体重减轻方面，但在恢复出生体重的天数方面，证明了显著改善。对365例新生儿在出生后18个月内应用气泡式CPAP进行呼吸支持。没有明显的技术问题，但有13%的患者记录到鼻子和面部的组织损伤，通常是短暂的。新的医疗记录改善了医生的记录，但护理人员不愿意使用它们。大学教学医院的死亡率从项目实施前18个月的23.6%下降到21.7%。两个地区医院的死亡率从10%降至8.1%。培训和改善护理的一个主要障碍是在新生儿病房工作的护士人数少和工作人员更替。这一卫生伙伴关系提供了一个由志愿专家进行能力建设的强化方案。护理和记录得到改善。成功引入CPAP。死亡率降低。这种形式可以适用于进一步的培训和改进计划，以提高设施为基础的护理质量。
A health partnership to improve hospital based neonatal care in Rwanda to reduce neonatal mortality was requested by the Rwandan Ministry of Health. Although many health system improvements have been made, there is a severe shortage of health professionals with neonatal training. Following a needs assessment, a health partnership grant for 2 years was obtained. A team of volunteer neonatologists and paediatricians, neonatal nurses, lactation consultants and technicians with experience in Rwanda or low-income countries was assembled. A neonatal training program was provided in four hospitals (the 2 University hospitals and 2 district hospitals), which focused on nutrition, provision of basic respiratory support with nasal CPAP (Continuous Positive Airway Pressure), enhanced record keeping, thermoregulation, vital signs monitoring and infection control. To identify if care delivery improved, audits of nutritional support, CPAP use and its complications, and documentation in newly developed neonatal medical records were conducted. Mortality data of neonatal admissions was obtained. Intensive neonatal training was provided on 27 short-term visits by 10 specialist health professionals. In addition, a paediatric doctor spent 3 months and two spent 6 months each providing training. A total of 472 training days was conducted in the neonatal units. For nutritional support, significant improvements were demonstrated in reduction in time to initiation of enteral feeds and to achieve full milk feeds, in reduction in maximum postnatal weight loss, but not in days for regaining birth weight. Respiratory support with bubble CPAP was applied to 365 infants in the first 18 months. There were no significant technical problems, but tissue damage, usually transient, to the nose and face was recorded in 13%. New medical records improved documentation by doctors, but nursing staff were reluctant to use them. Mortality for University teaching hospital admissions was reduced from 23.6% in the 18 months before the project to 21.7%. For the two district hospitals, mortality reduced from 10% to 8.1%. A major barrier to training and improved care was low number of nurses working on neonatal units and staff turnover. This health partnership delivered an intensive program of capacity building by volunteer specialists. Improved care and documentation were demonstrated. CPAP was successfully introduced. Mortality was reduced. This format can be adapted for further training and improvement programs to improve the quality of facility-based care.