A neonatal ward-strengthening program improves survival for neonates treated with CPAP at district hospitals in Malawi

Jennifer Carns; Sara Liaghati-Mobarhan; Aba Asibon; Samuel Ngwala; Elizabeth Molyneux; Maria Oden; Rebecca Richards-Kortum; Kondwani Kawaza; Alfred Chalira; Norman Lufesi

doi:10.1371/journal.pgph.0000195

A neonatal ward-strengthening program improves survival for neonates treated with CPAP at district hospitals in Malawi

PLOS Glob Public Health. 2022 Feb 18;2(2):e0000195. doi: 10.1371/journal.pgph.0000195. eCollection 2022.

Authors

Jennifer Carns^{1

2}, Sara Liaghati-Mobarhan¹, Aba Asibon¹, Samuel Ngwala¹, Elizabeth Molyneux³, Maria Oden^{1

2}, Rebecca Richards-Kortum^{1

2}, Kondwani Kawaza³, Alfred Chalira⁴, Norman Lufesi⁴

Affiliations

¹ Rice360 Institute for Global Health, Houston, TX, United States of America.
² Department of Bioengineering, Rice University, Houston, TX, United States of America.
³ Department of Paediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi.
⁴ Department of Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi.

Abstract

From 2013-2015, a CPAP quality improvement program (QIP) was implemented to introduce and monitor CPAP usage and outcomes in the neonatal wards at all government district and central hospitals in Malawi. In 2016 the CPAP QIP was extended into healthcare facilities operated by the Christian Health Association of Malawi. Although clinical outcomes improved, ward assessments indicated that many rural sites lacked other essential equipment and a suitable space to adequately treat sick neonates, which likely limited the impact of improved respiratory care. The aim of this study was to determine if a ward-strengthening program improved outcomes for neonates treated with CPAP. To address the needs identified from ward assessments, a ward-strengthening program was implemented from 2017-2018 at rural hospitals in Malawi to improve the care of sick neonates. The ward-strengthening program included the distribution of a bundle of equipment, supplemental training, and, in some cases, health facility renovations. Survival to discharge was compared for neonates treated with CPAP at 12 rural hospitals for one year before and for one year immediately after implementation of the ward-strengthening program. In the year prior to ward strengthening, 189 neonates were treated with CPAP; in the year after, 232 neonates received CPAP. The overall rate of survival for those treated with CPAP improved from 46.6% to 57.3% after ward strengthening (p = 0.03). For the subset of neonates with admission weights between 1.00-2.49 kg diagnosed with respiratory distress syndrome, survival increased from 39.4% to 60.3% after ward strengthening (p = 0.001). A ward-strengthening program including the distribution of a bundle of equipment, supplemental training, and some health facility renovations, further improved survival among neonates treated with CPAP at district-level hospitals in Malawi.

Copyright: © 2022 Carns et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work is made possible through the generous support of ELMA Philanthropies through a grant to the University of Malawi College of Medicine (https://www.elmaphilanthropies.org/, Grant No. 16-F0007). This manuscript is also made possible through the generous support of the Saving Lives at Birth (https://www.usaid.gov/global-health/health-areas/maternal-and-child-health/projects/saving-lives-birtha-grand-challenge) partners: The United States Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UKAID (Grant No. AID-OAA-A-13-00014). It was prepared by Rice University and does not necessarily reflect the views of the Saving Lives at Birth partners. Additionally, this work was supported by the John D. and Catherine T. MacArthur Foundation (https://www.macfound.org, Grant No. 17-1709-152484) the Bill & Melinda Gates Foundation (https://www.gatesfoundation.org, Grant No. OPP1193531), ELMA Philanthropies (https://www.elmaphilanthropies.org, Grant No. 19-F0012), The Children’s Investment Fund Foundation UK (https://ciff.org, Grant No. R-1810-03159), The Lemelson Foundation (https://www.lemelson.org, Grant No. 18-01458), and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.