Integrating a neonatal healthcare package for Malawi (IMCHA)
Programs and partnerships
Lead institution(s)
Summary
Malawi has the highest preterm delivery rate in the world. This, paired with inadequate newborn care at health facilities, results in high rates of infant mortality. Managing the healthcare needs of preterm infants remains a challenge.Read more
Malawi has the highest preterm delivery rate in the world. This, paired with inadequate newborn care at health facilities, results in high rates of infant mortality. Managing the healthcare needs of preterm infants remains a challenge. They face complications during and after birth, and they have an increased risk of death, chronic medical problems, and malnutrition later in life. Many life-saving interventions have been successful in Malawi but they have not been scaled up into routine clinical practice.
This project will determine whether a package of neonatal interventions, known as the Malawi Neonatal Package of Care, can be implemented at the health facility level to reduce neonatal mortality. Interventions include low-cost continuous airway support for breathing, breastfeeding support, Kangaroo Mother Care (skin-to-skin, mother-to-baby contact), hot cots to prevent hypothermia, management of hypoglycemia (low blood sugar), and phototherapy lights to treat jaundice. Researchers will investigate the best ways to implement these interventions in routine clinical practice.
The project will directly train nurses, doctors, and other health care providers. It will also produce peer-reviewed journal articles, and provide presentations at hospitals and nursing organizations, interviews with media, and policy-relevant information to decision-makers.
This is part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative,a seven year, $CA36 million multi-donor partnership funded by Global Affairs Canada, the Canadian Institutes of Health Research, and Canada's International Development Research Centre.
Research outputs
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The review evaluates the barriers and facilitators of bubble CPAP (continuous positive airway pressure) implementation, utilization and sustainability for newborn care at sub-Saharan African health facilities. It illustrates how different facility levels and types of bubble CPAP systems may impact utilization. Seventeen studies are included in the review. Reliable availability of equipment, effectively informing and engaging caregivers, and staffing shortages were frequently mentioned barriers to the implementation of bubble CPAP. Understaffed neonatal units and the high turnover of nurses and doctors compromises effective training.
The study explored the factors that influence the implementation of Continuous Positive Airway Pressure (bubble CPAP) among health care professionals in secondary and tertiary hospitals in Malawi. Influencing factors occurred in an interconnected manner and included: inadequate healthcare provider training; rigid division of roles and responsibilities among providers; lack of effective communication between providers and newborn’s caregivers; human resources constraints; and inadequate equipment and infrastructure. Complications of prematurity are the leading cause of neonatal deaths, an important consideration in Malawi, which has the highest rate of preterm births in the world, at 18% of live-births.
Health workers were interviewed from caregiver (parental and health provider) perspectives regarding therapeutic oxygen – Continuous Positive Airway Pressure (bubble CPAP) – and newborns. The study is part of a larger project to understand barriers and facilitators in implementing neonatal innovations in resource-constrained hospitals. Parental fears were especially strong if caregivers had previously seen or heard of a baby or elderly person who died while receiving oxygen. Negative perceptions of therapeutic oxygen may also be contextual due to experiences in Malawi in the pre- antiretroviral (ARV) treatments era, when mortality due to HIV/AIDs epidemic was high.
The paper evaluates the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi. It reports on limitations and lessons-learned using the WHO integrated quality of care assessment tool. Results reveal that quality of care requires improvement, particularly for sick and vulnerable newborns, and that the WHO assessment tool is helpful in examining the complex quality of care challenges at the district level. Facility assessments are one aspect of the study “Integrating a neonatal healthcare package for Malawi” which is part of the larger project “Innovating for Maternal and Child Health in Africa (IMCHA)” initiative.