Neonatal transport practices and effectiveness of the use of low-cost interventions on the morbidity and mortality of transported neonates in Sub-Saharan Africa: A systematic review protocol (original) (raw)
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Trials
Background There are 2.5 million neonatal deaths each year; the majority occur within 48 h of birth, before stabilisation. Evidence from 11 trials shows that kangaroo mother care (KMC) significantly reduces mortality in stabilised neonates; however, data on its effect among neonates before stabilisation are lacking. The OMWaNA trial aims to determine the effect of initiating KMC before stabilisation on mortality within seven days relative to standard care. Secondary objectives include exploring pathways for the intervention’s effects and assessing incremental costs and cost-effectiveness between arms. Methods We will conduct a four-centre, open-label, individually randomised, superiority trial in Uganda with two parallel groups: an intervention arm allocated to receive KMC and a control arm receiving standard care. We will enrol 2188 neonates (1094 per arm) for whom the indication for KMC is ‘uncertain’, defined as receiving ≥ 1 therapy (e.g. oxygen). Admitted singleton, twin and tr...
BMC Pregnancy and Childbirth, 2021
Background Hospital-based kangaroo mother care can help reduce preventable newborn deaths and has been recommended by the World Health Organization in the care of low birthweight babies weighing 2000 g or less. However, implementation has been limited. The objective of this review is to understand the barriers and facilitators of kangaroo mother care implementation in health facilities in sub-Saharan Africa, where there are the highest rates of neonatal mortality in the world. Methods A systematic search was performed on MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, African Journals Online, African Index Medicus as well as the references of relevant articles. Inclusion criteria included primary research, facility-based kangaroo mother care in sub-Saharan Africa. Studies were assessed by the Critical Appraisal Skills Programme Qualitative Checklist and the National Institutes of Health quality assessment tools and underwent narrative synthesis. Results Thirt...
Journal of Tropical Pediatrics, 2005
A randomized controlled trial was conducted over a 1-year period (November 2001-November 2002) in Addis Ababa to study the effectiveness of early Kangaroo mother care before stabilization of low birthweight infants as compared with the conventional method of care. There were 259 babies weighing less than 2000 g during the study period and a total of 123 (47.5 per cent) low birthweight infants were included in to the study. Sixty-two infants were enrolled as Kangaroo Mother Care (KMC) and the remaining 61 were Conventional Method of Care (CMC) cases. The demographic and socioeconomic characteristics for both groups were comparable. The mean age at the time of enrollment was 10 and 9.8 h for KMC and CMC, respectively (p`0.05 with 95 per cent confidence interval). The mean birthweight was 1514.8 g (range 1000-1900 g) for KMC and 1471.8 g (range 930-1900 g) for CMC (p`0.05 with 95 per cent CI) and the mean gestational age was 32.42 and 31.59 weeks for KMC and CMC cases, respectively. Fifty-eight per cent of KMC and 52 per cent of CMC cases were on i.v. fluid. Twenty-one of 62 (34 per cent) of KMC and 23/61 (37 per cent) of CMC babies were on oxygen through nasopharyngeal catheter. The mean age at exit from the study was 4.6 days for KMC and 5.4 days for CMC. Ninety-one per cent and 88 per cent of babies in KMC and CMC were discharged from the study in the first 7 days of life, respectively. The study showed that 14/62 (22.5 per cent) of KMC vs. 24/63 (38 per cent) CMC babies died during the study (p_0.05 and CI of 95 per cent.) The majority of deaths occurred during the first 12 h of life. Survival for the preterm low birthweight infants was remarkably better for the early kangaroo mother care group than the babies in the conventional method of care in the first 12 h and there after. More than 95 per cent of mothers reported that they were happy to care for their low birthweight babies using the early Kangaroo mother method. It was recommended to study the feasibility and effectiveness of Kangaroo mother care at the community level.
Neonatal transport practices in Ibadan, Nigeria
Pan African Medical Journal, 2016
Introduction: Neonatal transport involves moving sick neonates in optimal conditions to ensure good outcomes. It is well organized in most developed countries but receives little attention in developing countries where the highest burden of neonatal mortality exists and a large number of newborns require referrals daily for better medical care. This study sought to evaluate the modes of transport, pre-and intra-transport care of neonates referred to the University College Hospital (UCH), Ibadan, Nigeria. Methods: The methods of transporting 401 neonates presenting to the children's emergency room of the hospital were evaluated as well as the care the babies received during transport. Categorical variables were compared using the Chi square test while continuous variables were compared by the student t-test. Results: About a third presented in the first 12hours and 85% in the first week of life, all from within 80km radius. There were 67.1% term, 31.4% preterm and 1.5% post-term neonates, all without prior communication. The modes of transport included private vehicles (43.9%), commercial vehicles (40.6%), motorcycles (9.0%), ambulance (4.0%) and on foot (2.5%). Only 3 (0.7%) were transported in incubators and none in KMC position. Only 42.0% had referral letters and 7.0% were accompanied by medical personnel. Materials available during transport included Ambubags (3.7%), oxygen (3.5%) and some drugs (3.5%). Events during transport were apnoea, 4.7%, vomiting 1.0%, reduced activity 16.2% and seizures 13.7%. 19 (4.7%) neonates were dead on arrival. Pre-transport care included resuscitation (18.2%), intravenous fluid/feeding (24.4%) and supplemental oxygen (14.0%). Conclusion: Neonatal transport practices in Ibadan, Nigeria are abysmal with associated high mortality.
Newborn Transport Practices: Influence on Newborn Survival in Benin City, Nigeria
American Journal of Pediatrics, 2020
Objective: To assess the transfer process, modes of transportation, distances covered to access care, condition on arrival, and outcomes of newborns admitted to hospital in Benin City, Nigeria. Methods: This was a cross sectional survey of all consecutively presenting neonates to the children's emergency unit over a 12-month period. Their demographic information, antepartum and perinatal antecedents, clinical information, main complaint, and co-morbidities were noted on a structured questionnaire. Other information gathered included transfer process, mode of transport, distance covered to reach facility, interventions during transport, condition on arrival, and outcome. Data were analyzed using descriptive statistics, frequencies, and chi-square comparisons; significance was set at P<0.05. Results: Responsible persons for 115 babies-73 males and 42 females-completed the questionnaire. Of the newborns, 62 (53.9%) were of normal birth weight and 43 (37.3%) of low birth weight; of these 37 (32.2%) were preterm. Most cases arrived from peripheral hospitals without referral notes or prior contact with the receiving hospitals. There was no organized pre-or intra-transfer stabilization or medical interventions. Patients came mainly with relatives (89%) or healthcare workers (10%). They arrived in private cars (81%), and were not kept in warm clothes. Distance covered was 10-20 km for more than 50% and over 100 km for less than 8%. Perinatal asphyxia was the commonest reason for transfer (14%). Lower gestational age and cyanosis on presentation significantly affected survival, as only 13 of 25 (52%) with cyanosis and 23 of 37 (62.2%) preterm babies survived. Overall mortality was 30/ 115 (26.1%), and preterm mortality was significantly higher at 14/37 (37.8%). Conclusions: The neonatal transfer process is poorly developed. Prior contact with receiving hospitals is infrequent. Staffing, monitoring, and stabilizing interventions during transfer of sick newborns are inadequate. Transfer mode might have affected survival of preterm infants in particular.
Trials, 2020
Background Complications of preterm birth cause more than 1 million deaths each year, mostly within the first day after birth (47%) and before full post-natal stabilisation. Kangaroo mother care (KMC), provided as continuous skin-to-skin contact for 18 h per day to fully stabilised neonates ≤ 2000 g, reduces mortality by 36–51% at discharge or term-corrected age compared with incubator care. The mortality effect of starting continuous KMC before stabilisation is a priority evidence gap, which we aim to investigate in the eKMC trial, with a secondary aim of understanding mechanisms, particularly for infection prevention. Methods We will conduct a single-site, non-blinded, individually randomised, controlled trial comparing two parallel groups to either early (within 24 h of admission) continuous KMC or standard care on incubator or radiant heater with KMC when clinically stable at > 24 h of admission. Eligible neonates (n = 392) are hospitalised singletons or twins < 2000 g and...
Cureus, 2021
Background Kangaroo Mother Care (KMC) is a widely implemented intervention developed as an alternative form of care in low-and middle-income countries (LMICs) for neonates. The implementation of KMC has significantly reduced morbidity and mortality in very-low-birth-weight infants (VLBWIs). Aim To describe the maternal and neonatal characteristics and clinical outcomes in VLBWIs who received KMC at a tertiary hospital. Methods This is a retrospective descriptive study of 981 VLBWIs admitted at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over a six-year period (January 1, 2014, to December 31, 2019). Results The mean gestational age of infants admitted to the unit was 29.6 weeks (standard deviation (SD): 2.4), with a mean birth weight of 1185 g (SD: 205.6). The average duration of admission in the neonatal unit was 37 days. The mean rate of weight gain was 37.6 g/kg/day (SD: 57.6). The majority of infants were breastfed (61.4%). In our study, the prevalences of the complications of prematurity were as follows: respiratory distress syndrome (RDS), 84.2%; late-onset sepsis (LOS), 26.1%; and retinopathy of prematurity (ROP), 10.6%. The mortality rate was 3.1%. Maternal comorbidities include human immunodeficiency virus (HIV) (26.4%), syphilis (2.9%) and gestational hypertension (33.7%). The antenatal clinic attendance rate was good (84.7%). Conclusion KMC is a cost-effective alternative to conventional care for VLBWIs in limited-resource countries, with evidence of increased weight gain, less rates of complications of prematurity and low overall mortality. The provision of KMC facilities is urgently required in LMICs.
The Impact of Kangaroo Mother Care on the Outcome of Premature Babies at the Regional Hospital Buea
Journal of Pediatric Advance Research, 2022
Background: Prematurity and its complications are the leading causes of neonatal death. Kangaroo Mother Care (KMC) is one of the neonatal interventions to prevent these main complications, improve the outcome of preterm babies and reduce neonatal mortality due to prematurity. This study was conducted to assess the impact of KMC on the morbidity and mortality of premature babies in a semi-urban setting in Cameroon. Method: This study was a hospital-based retrospective cohort study carried out at the Buea Regional Hospital from February to April 2021. The files of neonate patients born before 37 weeks of completed pregnancy and who were hemodynamically stable were extracted and used. Participating babies selected were sorted into two groups: those who were cared for conventionally and those who were cared for through KMC. Some variables were obtained and compared between the 2 cohorts including: prevalence of hospitalisation, complications, duration of hospitalisation, mortality rate, rate of post discharge follow-up, rate of breastfeeding and increase in anthropometric parameters (head circumference, length and weight). Results: One hundred and twenty four premature babies were retained. Forty four of these were cared for conventionally and 80 cared for through KMC. Admissions significantly increased with KMC p<0.001). The main complications before and after KMC institution were and remained: infection, jaundice, respiratory distress and anaemia. There was a reduction in the frequency of some morbidities with KMC (infection, Necrotic Enterocolitis, hypoglycaemia and feeding difficulties), though the decrease was not statistically significant (p= 0.227, 0.285, 0.353 and 0.123 respectively). The frequency of respiratory distress, apnoea and hypothermia increased with KMC, but the changes were not significant (p= 0.551, 1.000 and 0.131 respectively). There was no significant change in duration of hospitalization between the cohorts (p= 0.637). Mortality rate reduced with KMC, though not significantly (p= 0.786). KMC significantly promoted the practice of exclusive breastfeeding both in hospital and at home (p<0.001). Post-discharge follow-up significantly improved after KMC was instituted (p<0.001). Head circumference and length increased, while weight reduced at discharge with KMC, but the changes were not statistically significant (p= 0.348, 0.118 and 0.438 respectively). Conclusion: KMC significantly increased admissions in this study. Mortality rate, infection and some other morbidities reduced, anthropometric parameters were better at discharge and postdischarge follow up improved for babies cared for through KMC. Implementation of KMC therefore has a positive effect on the outcome of preterm babies and should be intensified in resource-poor settings.
JBI Database of Systematic Reviews and Implementation Reports, 2019
The objective of this review is to explore the experiences of mothers with the practice of kangaroo mother care (KMC) for preterm neonates at home in sub-Saharan Africa. Introduction: About 7000 newborn babies die every day around the world. About 80% of these deaths occur in sub-Saharan Africa and southern Asia. Preterm birth and low birth weight (LBW) are major causes of newborn deaths in these regions. Kangaroo mother care is an alternative way to care for LBW preterm neonates; however, the rate of practice remains low. Studies have identified a range of barriers, primarily at the healthcare system level, but there is a dearth of evidence on the factors and enablers at the community level. Inclusion criteria: The review will consider studies conducted in sub-Saharan Africa on the perceptions and experiences of mothers who have given birth to preterm babies and have practiced KMC at home. Qualitative studies in English and French conducted from January 1979 to the present that exclusively use qualitative research methods including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research will be included. Methods: PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Academic Search Complete, CINAHL complete, Education Source and Health source: Nursing/Academic Edition will be searched. Eligible studies will be critically appraised using the standardized Joanna Briggs Institute tool. Findings will be pooled using the meta-aggregative approach, and confidence will be assessed according to the ConQual approach.