Mazia: Testing New Indicators in the Dominican Republic

7/28/2019 Mazia: Testing New Indicators in the Dominican Republic

1/17

Tes

tingnew

program

in

dica

tors

inthe

Dom

inican

Repu

blic

Go

ldyMazia,MD,MPH

Newborn

TechnicalAdvisorMC

HIP

Coordinator-LACNeonatalAllia

nce

GlobalNewbornHealthConference

Johannesburg,SouthAfrica

April16th,2013


2/17

Presen

tation

Ou

tline

Re

leva

ntbac

kgroun

donnew

bornprogra

ms

in

the

DR

Measu

ring

indicators

fornew

born

infections,

KMC,a

ndHBB/EN

Ca

tbirth

Cha

llenges

Lessons

learne

d


3/17

MCHIPNewbornHealthW

orkinthe

DR

Startedw

ithBASICSin

2007;DRMissionsupport

since

Collabora

tionforscale

-upwithbilateral(AbtAsso

ciates)

Materna

landChildC

entersofExcellenceProject(8of

9healthr

egions)

Program

willfinishinDecember2013

TheDRp

ioneeredUSA

ID/MCHIPfun

dedKMCand

HBB

inLAC

TransfertoMOHandp

artners:

HBBcu

rren

tly

isna

tiona

lprogram

4KMCcen

ters;a

dvocac

yforup

take

from

MOH

QIo

fmanagemen

to

fne

wbornseps

isonsca

le-up

bycon

tinues

withCen

terso

fExce

llen

ce

Pro

jec

t

3


4/17

M

easuring

KMCInd

ica

tors

Programstartedin2

009;one

regiona

lhospitaltrainedinKMC

Founda

tioninBogot

a(became

nationa

ltrainingcen

ter)

3additionalhospitalstrainedloca

lly

SNLKM

Cindicators

adaptedandmeasuredfrom

start

MCHIP

creatingauto

mateddatabase(togenera

te

indicatorsandgraph

s)-willbeava

ilableforcountries

foradaptation

4


5/17

Curren

tDa

taCo

llec

tionT

oo

l(KMC

-A)

5

Date

offirst

visit

File

num

ber

Mothername

Mother

age

Address

Phone

Nameo

f

baby

Sex

Dateo

f

birth

Placeo

f

birth

Typeo

f

de

livery

(1=

vag

inal

;2

=C

-

section;

3=

mu

ltiple

)

Birth

w

eight

Gest

ation

al

age

Firstv

isit

We

ight

Chron

olog

ic

age

Corre

cte

d

age

KMC

pos

iti

on

(yes

/

no

)Fee

ding

(1

=exc

lu

sive

breastfee

dintg;

2=

other)

Com

plicati

ons

(desc

ribe

)

We

ight

ga

ins

ince

disc

harge


6/17

Se

lec

tedcurre

ntindicatorsresu

lts

HOSPITAL

Da

teKMC

starte

d

Tra

ine

dby

#new

borns

inKMC

Proportion

of

eligible

newbornsin

theKMC

program

#an

d

proport

iono

f

dea

ths

inKMC

ba

bies

Prop

ort

iono

f

b

abies

aba

ndon

ing

KMCF/U

HSVP*

May

2009

KMC

Foun

da

tion

Bogota

478

90%

4

(0.8

%)

2.5

%

MSLM

January

2012

HSVP

427

38%

5(1

.1%)

10%

Mori

llo

King

Fe

bruary

2013

HSVP

40

N/A

0

0%

Musa

Apri

l4th

2013

HSVP

3

N/A

0

N/A

6


7/17

7

0510

15

20

25

30

35

40

45

50

2008

2009

2010

20

11

2012

46

44

24.

5

30

42.

1

KMCan

dNeona

tal

Morta

lityin

Tra

ining

Cen

ter

inth

eDR(HSVP

)

NMRper1,000livebirths


8/17

8

010

20

30

40

50

60

70

80

90

100

2008

2009

2010

201

1

2012

78%

67%

64%

61%

90%

Proportionofnewborndeathsinprematures/LBW

Re

duction

inmorta

lityo

fprema

ture

/LBW

b

abies

since

KMCim

plemen

tati

on

(HSVP)


9/17

9

Na

tiona

limp

leme

ntationofH

elping

Bab

ies

Brea

the

(HBB)inth

eDR

Initiated

inJuneof2010(globallaunchinWDC);

training

of4nationalmastertrainers

TranslatedmaterialsintoSpanish,adaptationof

pictures

forLAC

7nationalmastertrainers,

30facilitators,

300

provider

sin10CentersofExcellen

ce(collaboration

withUSAIDbilateral)in8of9regions;continuing

Equipmentforservice

provisionin

processof

distributionbybilateral(indicator)

Collectin

gGDAindica

tors(plusEN

Catbirth);us

ing

addedre

gisterfordeliveryroom(~

toMCHIPMalawi

example

);developing

automatized

database


10/17

10


11/17

11

Crie

d/brea

the

d

atbirth

1.

Yes

2.

No

Re

susc

ita

tion

goldenm

inu

te:

1.

None

2.A

sp

ira

tionan

d

s

timu

lation

4.B

agan

dmas

k

v

en

tilation

5.

Advance

d

re

susc

ita

tion

Brea

thed

after

resusc

itatio

n

1.

Yes

2.

No

Tempera

ture

ma

intenance:

1.

Drie

dimme

diately

an

dpu

tins

kin-to-

skincon

tac

t

2.

Drie

dan

dwrappe

d

3.

Drie

dan

dpu

t

un

derwarmer

4.

None

Cord

cu

tting:

1.

Steri

le

ins

trumen

t

2.

Non

steri

le

ins

trumen

t

Eye

prop

hy

laxis

:

1.

Yes

2.

No

BFfirs

t

hour:

1.

Yes

2.

No

HBB/ENCDa

taC

ollec

tion

To

ol(snapsho

t)


12/17

12

Someillustrative

examples

(Jan-Mar2013)

HOSPITAL

TOTAL#

BABIES

#(%)OF

BABIES

NOT

CRYINGOR

BREATHING

ATBIRTH

#(%)BABIES

RESUSCIT

ATED

WITHBAG

AND

MASK

VENTILATION

WARMTH

MAINTENANCE

EYE

PROPHYLAXIS

STER

ILE

INSTR

UM

TOC

UT

COR

D

BFIN

FIRST

HOUR

MUSA

213

15

(7%)

8(4%)

100%

94%

100%

73%

MSLM

1,8

51

43

(2.3

%)

10

(0.5%

)

99%

89

.1%

100%

21

.2%

HSVP

157

18

11

.4%

0%*

100%

100%

100%

82%


13/17

13

Qua

lityimprove

men

to

fnew

bornseps

is

managemen

tat

the

fac

ilityleve

lintheD

R

Partofregionalstrate

gysince2007

(virtualsessions

forexch

anges);currently10center

sinvolved.One

champio

nedandismentoringothers

Whatind

icatorstouse?

Propo

rtionofobserv

edstaffcompl

yingwithcorre

ct

techniqueandrecom

mendedtimes

forhandwash

ingfor

newborncare

Propo

rtionofobserv

eddeliveriesa

pplyingelementsof

clean/steriledelivery

(cleanhands,

sterilelinen,s

terile

instrumentforcordcutting,cleans

paces,etc.)

Propo

rtionofadmissionstothenurserydueto

suspe

ctednosocomialinfection(basedonCDC

definition)


14/17

14

01020304050 Jun'0

7AugOctDe

cFeb

'08AprJunAg

oOctDec Feb

'09Ab

rJunA

ugOctDe

cJan

'10FebMar

Month

Percentage

Adm

iss

ions

forsuspec

tedh

osp

ita

l-acqu

ired

infec

tion-

One

reg

iona

l

h

osp

ita

l3yearfo

llow-up

Dom

in

ican

Repu

blic

Someac

hievem

en

ts


15/17

15

Ch

allenges

Incorporationofnewneonatalindic

ators;mainly

new

andstill

beingtested

Technicalstaffnotusedtodatacol

lectionand

analysis

,perceivinga

sadditionofunnecessarywork

Needforperiodicqua

litycontrolof

datacollectio

n

Frequen

trotationofs

taffrequiresf

requenttrainingsin

datacollectionandan

alysis

Complexityofdataco

llectiontools


16/17

16

Lessons

learn

ed

Advocac

yandfrequentsharingofresults

tocentra

llevelauthor

ities:MOHinvited

MCHIPtorecommend

newbornindicators

forinclu

sionintoHMIS

Results

measurementandsharing

stimulatestafftocom

plywithchan

ges

andmea

sureroutinely

Friendly

competitionamongcenter

s

User-frie

ndlytools-Automatizewherepossible

Pioneeringstimulate

scommitmen

t


17/17

17

Siyabo

nga-

Than

ks

Mazia: Testing New Indicators in the Dominican Republic

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Transcript of Mazia: Testing New Indicators in the Dominican Republic