FROM EVIDENCE TO ACTION: FEASIBILITY OF IMPLEMENTING COMMUNITY- AND FACILITY-BASED NEONATAL INTERVENTIONS IN DISPLACED PERSON CAMPS IN SOUTH SUDAN

newborn;South Sudan;Public Health Studies

Sami, SamiraCohen, Joanna ;

Johns Hopkins University

关键词: newborn;    South Sudan;    Public Health Studies;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60222/SAMI-DISSERTATION-2017.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

An estimated 2.7 million deaths will occur this year during the neonatal period, defined as the first 28 days of life. The highest rates of neonatal mortality occur in countries that have recently experienced conflict. Consequently, an inter-agency collaboration of partners drafted the Newborn Health in Humanitarian Settings Field Guide to improve health service delivery for newborns. The feasibility of implementing a package of community- and facility-based neonatal interventions in an ongoing humanitarian crisis is unknown. This study implemented an intervention package in four displaced person camps in South Sudan from June to November 2016, including: (1) clinical training for health workers with ongoing supportive supervision; (2) distribution of newborn-specific medical commodities for the community, primary care, and hospital level; and (3) planning workshop for senior managers to prioritize programmatic considerations. The intervention was implemented in two internally displaced person camps located in Juba and Malakal, and two refugee camps in Maban. Study aims were to: 1) describe the state of newborn facility-level care prior to intervention, 2) explore community and facility health workers’ knowledge and attitudes toward neonatal interventions before and after receiving training, and 3) explain the main health system bottlenecks for implementing a package of newborn interventions during humanitarian crisis. We found that health facilities in our study sites lacked the medical commodities and skilled staff to provide continuous newborn care prior to intervention. However, we observed a high proportion of newborns receiving essential practices during the delivery and immediate postnatal period. Skin-to-skin contact, postnatal monitoring, and partograph use for fetal monitoring were the least common practices. This suggests that practices most critical for small and sick newborns needed further attention. Post-intervention, health workers increased their knowledge and improved their attitudes toward adoption of newborn practices. Data from multiple sources identified leadership and governance for comprehensive services, health workforce for skilled care at birth, and service delivery for small and sick newborns to be the main health system bottlenecks negatively influencing implementation during a six-month period. We identified potential solutions that enhance facilitators and overcome barriers to care in the context of a humanitarian crisis.