Background: Neonatal mortality remains a serious health issue especially in low resource countries, where 99% of\nneonatal deaths occur. Doctors with Africa CUAMM is an Italian non-governmental organization in the field of\nhealthcare that has been working in Africa since 1955. In Mozambique, at the Central Beira Hospital (CBH), it has a\nproject with the aim of supporting the neonatal intensive care unit (NICU) and the Obstetrical Department of the\nCBH through a multi-level intervention. Our aim was to evaluate the effectiveness of CUAMM continuous Quality\nImprovement intervention in terms of reduction of the overall neonatal mortality rate in the NICU of CBH.\nMethods: A baseline analysis was performed in order to assess the actual standard of neonatal care. Subsequently,\nthe intervention was focused on three main areas: infrastructure, equipment and clinical protocols improvement.\nA retrospective pre- (2013)/post- (2014) implementation analysis of clinical outcomes was performed.\nResults: Total population included 4,276 newborns, 2,118 (50%) born in 2013 and 2158 (50%) born after implementation.\nBaseline characteristics of the two groups were similar apart from a higher incidence of outborn neonates (33%\nvs 30%, p = 0.02) and a lower incidence of Apgar score < 7 at 5 min (37% vs 43%, p < 0.01). The rates of admissions for\nasphyxia (22% vs 30%), sepsis (4% vs 7%) and prematurity (18% vs 28%) increased between the two study period.\nMortality rate for each of these causes decreased from before to after the implementation: asphyxia (34% vs 19%,\np < 0.01), sepsis (39% vs 28%, p = 0.06) and prematurity (43% vs 33%, p < 0.01).\nConclusion: We found a reduction in mortality rate among newborns admitted to CBH�s NICU after the first year\nof CUAMM intervention. Most of this reduction can be attributed to the decrease in deaths for asphyxia, sepsis\nand prematurity. A Quality Improvement intervention based on infrastructural, equipment and clinical objectives\nwas associated with a reduction of neonatal mortality rate in a low-resource NICU.
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