Quality of care for neonates admitted to neonatal intensive care units in central Ethiopia

Abstract

Neonatal and maternal deaths are attributable to low quality of care, however, the deaths are preventable. In Ethiopia, the low neonatal survival rate contributes to more than 56% of under-5 deaths. The purpose of the study was to assess the quality of care for neonates admitted to the neonatal intensive care units (NICUs) in order to develop strategies to strengthen the quality of NICU care services. The study employed a parallel mixed methods design and was conducted in six NICUs of public hospitals in Central Ethiopia. A thematic analysis of the qualitative data was undertaken using ATLAS.ti 6.2. and quantitative data analysis was undertaken using SPSS Windows version 23. After separate analysis, the quantitative and qualitative results were integrated to address the research purpose. The results revealed that of the neonates admitted to NICUs, 83% of them survived while most (75%) of the deaths occurred within the first week of life. Neonates with low admission weight, perinatal asphyxia, and congenital malformation had a higher risk of death compared to neonates without these conditions. Limited access to training; designs and organization of NICU rooms; shortage of supplies and functional equipment were among the key factors affecting quality of care in the NICUs. The study revealed challenges with the provision of care, which were related to the healthcare workforce, the physical resources, and the experience of care provided in the study NICUs. Five strategies were developed to strengthen the quality of neonatal intensive care based on the findings of the study; which were to strengthen the technical capacity of the neonatal intensive care staff; improve professional risk compensation benefit for the NICU staff; enhance the NICUs to provide high-quality neonatal intensive care; strengthen the availability of functional essential equipment, supplies, and medications that are needed for the provision of quality neonatal intensive care; and to pay special attention to sick neonates and neonates with low birth weight on admission, perinatal asphyxia, and congenital malformation in the neonatal intensive care process. The strategies could be used to improve service integration, strengthening the referral system, and improving the experience of mothers and families of neonates admitted in the NICUs.