Background Neonatal mortality remains high in Ethiopia at 35/1000, despite improvements in reducing the overall child mortality. Through the RCPCH VSO Fellowship a Paediatric trainee was placed in Arba Minch Hospital, in the south of Ethiopia, alongside a GP VSO (Voluntary Service Overseas) volunteer. The placements were funded by UNICEF, with the aim of implementing measures to reduce neonatal mortality in the region.
Needs assessment Initial assessment revealed there was a lack of knowledge and skills in neonatal resuscitation and newborn care. Local neonatal mortality rate in Arba Minch Hospital over an 8 month period was significantly higher than the national average at 175.4/1000. Following discussion with relevant staff a two-pronged approach was adopted:
Establish a basic neonatal unit.
Provide basic training in neonatal care and resuscitation.
Methods A successful grant application led to funding for training from UNICEF and equipment from Irish Aid. A total of 89 relevant staff received training in neonatal care and resuscitation. 75 out of 89 participants completed feedback forms and 80 candidates completed pre and post course tests. Data on admissions and mortality were collected prior to the unit opening and over a 6 month period after the unit was opened.
Results Admission of neonates increased 3 fold, from 4.8% to 15% of total paediatric admissions, following the establishment of the neonatal unit. Mortality reduced from 17.5% to 15%. Following the course 81.25% of participants improved their score from pre to post course tests. Feedback showed 81.3% of people felt their confidence in neonatal resuscitation was 10/10 following the course.
Conclusion The increase in neonatal admissions highlighted a previously unmet need. Early figures indicate the mortality is reducing, in spite of the 3 fold increase in admission of sick babies. The training led to receiving appropriate referrals coupled with improved confidence in newborn care and resuscitation. Arba Minch Neonatal Unit has become a centre of training and a model for future neonatal units developing in neighbouring hospitals. The project also met the requirements for an example of best practice in VSO Ethiopia and therefore a prototype for future VSO partnerships to adopt.