Abstract：
Pakistan is facing a challenging situation in terms of high newborn mortality rate. Securing pregnancy and delivery care may not bring a substantial reduction in neonatal mortality, unless coupled with the provision of quality inpatient care for small and sick newborns and young infants (NYIs). We undertook this study to assess the availability and quality of newborn care services provided and the readiness of inpatient care for NYIs in Pakistan.
We conducted a cross-sectional study across Pakistan from February to June 2019, using a purposive sample of 61% (23) of the 38 sick newborn care units at public sector health care facilities providing inpatient care for small and sick NYIs. We interviewed facility managers and health care providers by using structured questionnaires. We observed facility infrastructure and relevant metrics related to the quality of inpatient care such as types of infant care units and essential equipment, drugs, staffing cadre and facility management practices, quality assurance activities, essential services for small and sick NYI care, discharge planning, and support, quality of NYIs care record, and health information system.
Of the 23 facilities assessed, 83% had newborn intensive care units (NICUs), 74% reported Special Care Units (SCUs), and only 44% had Kangaroo Mother Care (KMC) Units. All facilities had at least one paediatrician, 13% had neonatologists and neonatal surgeons each. Around 61 and 13% of the facilities had staff trained in neonatal resuscitation and parental counseling, respectively. About 35% of the facilities monitored nosocomial infection rates, with management and interdisciplinary team meetings reported from 17 and 30% of the facilities respectively preceding the survey. Basic interventions for NYIs were available in 43% of the facilities, only 35% of facilities had system in place to monitor nosocomial infections for NYI care. Most (73%) of reviewed records of NYIs at 1-2 days had information on the birth weight, temperature recording (52%), while only a quarter (25%) of the observed records documented danger signs. Mechanism to support discharge care by having linkages with community workers was present in 13% of the facilities, while only 35% of the facilities have strategies to promote adherence after discharge. Majority (78%) of facilities reported monitoring any newborn/ neonatal care indicators, while none of the sub-units within facilities had consolidated information on stillbirths and neonatal deaths.
The study has demonstrated important gaps in the quality of small and sick NYI inpatient care in the country. To avert neonatal mortality in the country, provincial and district governments have to take actions in improving the quality of inpatient care.
We conducted a cross-sectional study across Pakistan from February to June 2019, using a purposive sample of 61% (23) of the 38 sick newborn care units at public sector health care facilities providing inpatient care for small and sick NYIs. We interviewed facility managers and health care providers by using structured questionnaires. We observed facility infrastructure and relevant metrics related to the quality of inpatient care such as types of infant care units and essential equipment, drugs, staffing cadre and facility management practices, quality assurance activities, essential services for small and sick NYI care, discharge planning, and support, quality of NYIs care record, and health information system.
Of the 23 facilities assessed, 83% had newborn intensive care units (NICUs), 74% reported Special Care Units (SCUs), and only 44% had Kangaroo Mother Care (KMC) Units. All facilities had at least one paediatrician, 13% had neonatologists and neonatal surgeons each. Around 61 and 13% of the facilities had staff trained in neonatal resuscitation and parental counseling, respectively. About 35% of the facilities monitored nosocomial infection rates, with management and interdisciplinary team meetings reported from 17 and 30% of the facilities respectively preceding the survey. Basic interventions for NYIs were available in 43% of the facilities, only 35% of facilities had system in place to monitor nosocomial infections for NYI care. Most (73%) of reviewed records of NYIs at 1-2 days had information on the birth weight, temperature recording (52%), while only a quarter (25%) of the observed records documented danger signs. Mechanism to support discharge care by having linkages with community workers was present in 13% of the facilities, while only 35% of the facilities have strategies to promote adherence after discharge. Majority (78%) of facilities reported monitoring any newborn/ neonatal care indicators, while none of the sub-units within facilities had consolidated information on stillbirths and neonatal deaths.
The study has demonstrated important gaps in the quality of small and sick NYI inpatient care in the country. To avert neonatal mortality in the country, provincial and district governments have to take actions in improving the quality of inpatient care.
摘要：
巴基斯坦面临着高新生儿死亡率的挑战。确保怀孕和分娩护理可能不会大幅降低新生儿死亡率，除非再为小型和患病的新生儿和幼儿（NYI）提供优质的住院护理。我们进行了这项研究，以评估所提供的新生儿护理服务的可用性和质量以及巴基斯坦NYIs住院护理的准备情况。
我们于2019年2月至6月在巴基斯坦进行了一项横断面研究，使用了公共部门医疗保健机构38个患病新生儿护理单位中61％（23个）的目的性样本，为小型和患病的NYIs提供住院护理。我们通过使用结构化问卷采访了设施经理和医疗保健提供者。我们观察了与住院护理质量相关的设施基础设施和相关指标，如婴儿护理单元和基本设备的类型，毒品,人员编制和设施管理实践，质量保证活动，小型和生病的NYI护理的基本服务，排放规划,和支持,NYI护理记录的质量，和健康信息系统。
在评估的23个设施中，83%的人有新生儿重症监护病房(NICU)，74%报告了特殊护理单位(SCU)，只有44%有袋鼠母亲护理(KMC)单位。所有设施都至少有一名儿科医生，13%有新生儿科医师和新生儿外科医师。大约61％和13％的设施拥有接受过新生儿复苏和父母咨询培训的工作人员，分别。约35%的设施监测医院感染率,调查前，分别有17%和30%的设施报告了管理层和跨学科小组会议。43%的设施提供了对NYI的基本干预措施，仅有35%的设施建立了NYI护理的医院感染监测系统.在1-2天的NYI审查记录中，大多数（73％）都有有关出生体重的信息，温度记录（52%），而只有四分之一(25%)的观察记录记录了危险迹象。通过与社区工作者建立联系来支持出院护理的机制在13％的设施中存在，而只有35%的设施有促进出院后依从性的策略。大多数（78％）的设施报告监测任何新生儿/新生儿护理指标，而设施内的任何一个亚单位都没有关于死产和新生儿死亡的综合信息。
该研究表明，该国小型和病态NYI住院护理的质量存在重大差距。为了避免该国的新生儿死亡，省和区政府必须采取行动提高住院护理质量。
我们于2019年2月至6月在巴基斯坦进行了一项横断面研究，使用了公共部门医疗保健机构38个患病新生儿护理单位中61％（23个）的目的性样本，为小型和患病的NYIs提供住院护理。我们通过使用结构化问卷采访了设施经理和医疗保健提供者。我们观察了与住院护理质量相关的设施基础设施和相关指标，如婴儿护理单元和基本设备的类型，毒品,人员编制和设施管理实践，质量保证活动，小型和生病的NYI护理的基本服务，排放规划,和支持,NYI护理记录的质量，和健康信息系统。
在评估的23个设施中，83%的人有新生儿重症监护病房(NICU)，74%报告了特殊护理单位(SCU)，只有44%有袋鼠母亲护理(KMC)单位。所有设施都至少有一名儿科医生，13%有新生儿科医师和新生儿外科医师。大约61％和13％的设施拥有接受过新生儿复苏和父母咨询培训的工作人员，分别。约35%的设施监测医院感染率,调查前，分别有17%和30%的设施报告了管理层和跨学科小组会议。43%的设施提供了对NYI的基本干预措施，仅有35%的设施建立了NYI护理的医院感染监测系统.在1-2天的NYI审查记录中，大多数（73％）都有有关出生体重的信息，温度记录（52%），而只有四分之一(25%)的观察记录记录了危险迹象。通过与社区工作者建立联系来支持出院护理的机制在13％的设施中存在，而只有35%的设施有促进出院后依从性的策略。大多数（78％）的设施报告监测任何新生儿/新生儿护理指标，而设施内的任何一个亚单位都没有关于死产和新生儿死亡的综合信息。
该研究表明，该国小型和病态NYI住院护理的质量存在重大差距。为了避免该国的新生儿死亡，省和区政府必须采取行动提高住院护理质量。
