Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica

BMC Pediatrics

Casey K. Johanns¹  Bernardo Hernandez¹  Maximilian G. Thom¹  Katie Panhorst Harris¹  Ali H. Mokdad¹  Aruna M. Kamath²  Paola Zuniga-Brenes³  José C. Ochoa⁴  Karla Schwarzbauer⁴  Diego Rios-Zertuche⁴ 

[1] Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, 98195, Seattle, WA, USA;Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, 98195, Seattle, WA, USA;Department of Anesthesiology, University of Washington, Seattle, WA, USA;Inter-American Development Bank, San José, Costa Rica;Inter-American Development Bank, Washington, DC, USA;

关键词: Birth asphyxia;    Intra-partum related hypoxia;    Neonate;    Newborn;    Quality of care;    Central America;    Mexico;    Honduras;    Nicaragua;    Guatemala;   

DOI  :  10.1186/s12887-021-02999-0

来源: Springer

【 摘 要 】

BackgroundIntrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region.MethodsA pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011–2013) and at second-phase follow-up (2017–2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression.ResultsManagement of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3–4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4–12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%).ConclusionSMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.

【 授权许可】

CC BY