Transforming care for every small and sick newborn #EveryNewborn #EveryNewborn #EveryChildAlive #EveryChildAlive
Data for Action: Namibia’s Maternal and Perinatal Death Surveillance and Response Dr Alexander Manu (University of Ghana School of Public Health and Consultant, UNICEF) WHO/UNICEF MNCAH Webinar – 30 th June 2020 - 29 April 2020
Addressing the problem of PDSR based on data What were the documented challenges? ▪ Non-existent or variable functionality of Review Committees; often maternal focused. ▪ Recommendations not implemented and so recur ▪ Staff commitment waned Incremental intensity of technical support ▪ MDSR too weak to support many perinatal ▪ Training (hands-on) - May/Sep. deaths ▪ Practical sessions: observations - Sep/Nov ▪ Like always, newborns fall between the cracks ▪ Follow-on support - Nov – not well counted
Trends in Neonatal Mortality, Stillbirth and Perinatal Mortality Rates – Summary of 3 intermediate referral hospitals 120.0 111.7 102.3 100.0 99.0 90.5 84.7 80.0 79.0 76.5 73.3 72.0 66.1 62.2 60.0 59.5 53.3 53.6 45.8 43.1 40.0 33.6 32.9 31.8 26.5 22.0 20.0 0.0 JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL The averages never tell the entire story NMR SBR PMR
Neonatal Mortality Rate (iNMR) per 1000 Livebirths 35.0 31.5 Jan-Mar 2019 30.0 Mean NMR = 16.1 Jan-Mar 2020 Median NMR = 18.1 25.0 24.0 Mean NMR = 12.4 21.4 Median NMR = 13.2 20.0 18.7 1 st Training 18.1 15.0 13.9 13.2 11.8 11.4 10.8 10.6 10.0 10.0 5.3 5.0 4.7 2.2 0.0 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 2 nd Training; focus on data quality and implementing recommendations
▪ A simple, bespoke Excel Spreadsheet developed to capture data from the surveillance, assess trends in Stre trengthening th the indicators “R”s Data System ▪ A color-coded sheet to track implementation of the recommendations
How did they get there? Implementing recommendations
Data showing success motivates BUT must be measured ▪ In Kunene and Oshakati, functional MPDSR process highlighted the capacity gaps in care especially for small and sick newborns – Used as advocacy for intermediate skills development for staff – An MO sponsored to learn the use of ultrasound scan (SONA) to assess fetal wellbeing during pregnancy and labour “ In one of our previous meetings, we had a woman who was brought in late with eclampsia and our focus was to stabilise her before surgery and we lost both mother and baby. This time round, we saw that the mother was not responding to the treatment, we decided to go in and save the baby even if we were going to lose the mother. Alhough we lost the mother, the baby was saved. We would not have done that if we had not previously discussed the previous case at the meeting. I think it will take time but will make a difference ” [Midwife]
Thanks, but before I go…. ▪ Start small but be informed by data ▪ Use of data will improve quality
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