Reduced neonatal mortality in a regional hospital in Mozambique linked to a Quality Improvement intervention.
Reduced neonatal mortality in a regional hospital in Mozambique linked to a Quality Improvement intervention.
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DOI：
10.1186/s12884-016-1170-y
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发表时间：
2016-11-22
影响因子：
3.1
通讯作者：
Trevisanuto D
中科院分区：
文献类型：
--
作者：
Cavicchiolo ME;Lanzoni P;Wingi MO;Pizzol D;Daverio M;Da Dalt L;Putoto G;Trevisanuto D
新生儿死亡率仍然是一个严重的健康问题，特别是在低资源国家，99%的新生儿死亡发生在那里。CUAMM医生与非洲协会是意大利的一个医疗保健领域的非政府组织，自1955年以来一直在非洲开展工作。在莫桑比克，本组织在贝拉中央医院实施了一个项目，目的是通过多层次的干预，支持贝拉中央医院的新生儿重症监护室和产科。我们的目的是评估CUAMM持续质量改进干预在降低CBH NICU总体新生儿死亡率方面的有效性。进行基线分析，以评估新生儿护理的实际标准。随后，干预措施集中在三个主要领域：基础设施、设备和临床方案的改进。对临床结局进行了回顾性实施前（2013年）/实施后（2014年）分析。总人口包括4，276名新生儿，2，118名（50%）出生于2013年，2，158名（50%）出生于实施后。两组的基线特征相似，除了外生新生儿的发生率较高（33% vs 30%，p = 0.02）和5分钟Apgar评分<7的发生率较低（37% vs 43%，p <0.01）。在两个研究期间，因窒息（22%对30%）、败血症（4%对7%）和早产（18%对28%）而入院的比例增加。从实施前到实施后，这些原因中的每一个的死亡率都有所下降：窒息（34%对19%，p <0.01），败血症（39%对28%，p = 0.06）和早产（43%对33%，p <0.01）。我们发现，在CUAMM干预的第一年后，CBH的NICU新生儿死亡率有所下降。这一减少主要归因于窒息、败血症和早产死亡的减少。基于基础设施、设备和临床目标的质量改进干预与低资源NICU中新生儿死亡率的降低相关。
Neonatal mortality remains a serious health issue especially in low resource countries, where 99% of neonatal deaths occur. Doctors with Africa CUAMM is an Italian non-governmental organization in the field of healthcare that has been working in Africa since 1955. In Mozambique, at the Central Beira Hospital (CBH), it has a project with the aim of supporting the neonatal intensive care unit (NICU) and the Obstetrical Department of the CBH through a multi-level intervention. Our aim was to evaluate the effectiveness of CUAMM continuous Quality Improvement intervention in terms of reduction of the overall neonatal mortality rate in the NICU of CBH. A baseline analysis was performed in order to assess the actual standard of neonatal care. Subsequently, the intervention was focused on three main areas: infrastructure, equipment and clinical protocols improvement. A retrospective pre- (2013)/post- (2014) implementation analysis of clinical outcomes was performed. Total population included 4,276 newborns, 2,118 (50%) born in 2013 and 2158 (50%) born after implementation. Baseline characteristics of the two groups were similar apart from a higher incidence of outborn neonates (33% vs 30%, p = 0.02) and a lower incidence of Apgar score < 7 at 5 min (37% vs 43%, p < 0.01). The rates of admissions for asphyxia (22% vs 30%), sepsis (4% vs 7%) and prematurity (18% vs 28%) increased between the two study period. Mortality rate for each of these causes decreased from before to after the implementation: asphyxia (34% vs 19%, p < 0.01), sepsis (39% vs 28%, p = 0.06) and prematurity (43% vs 33%, p < 0.01). We found a reduction in mortality rate among newborns admitted to CBH’s NICU after the first year of CUAMM intervention. Most of this reduction can be attributed to the decrease in deaths for asphyxia, sepsis and prematurity. A Quality Improvement intervention based on infrastructural, equipment and clinical objectives was associated with a reduction of neonatal mortality rate in a low-resource NICU.
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