6658 Using routinely collected hospital data from low-resource settings to identify current practices and areas of improvement in newborn care

Objectives Sub-Saharan Africa accounts for the highest newborn deaths worldwide, but approximately 80% of these deaths can be prevented.1 International guidelines for newborn quality of care (QoC) can be used for taking measures to reduce neonatal morbidity and identify areas for improvement. The aim of this study was to assess newborn QoC in low-resource settings by using routinely collected data to measure indicators derived from international guidelines. Methods Recent guidelines from the WHO standards of care for small and sick newborns2 and Every Newborn Action Plan (ENAP)3 were compared with routinely collected data from three tertiary hospitals. Data were collected using Neotree,4 a quality improvement tool that combines prospective data capture for tracking of quality improvement metrics, education and clinical decision support for newborn care – implemented in Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH) in Zimbabwe, and Kamuzu Central Hospital (KCH) in Malawi. Retrospective and descriptive analyses of data were conducted for all newborns admitted in between January 1, 2021 and April 30, 2023. Results In total 29 QoC indicators (table 1) were captured by Neotree data. Total neonatal admissions across all three hospitals were 18,397 (10,324 in SMCH, 1,817 in CPH and 6,256 in KCH), and case fatality rate (CFR) over the study period was 158 in SMCH, 156 in CPH and 193 in KCH (per 1000 live admissions). Birth weight, body temperature, respiratory rate, feeding behaviour and danger signs were documented for nearly all neonates. Among hypoxic newborns, 79~85% were administered blended oxygen therapy. Of newborns who did not cry immediately after birth, 64.6% in SMCH, 88.7% in CPH and 80.1% in KCH had resuscitation actions started with bag and mask or stimulation. The most common causes of death across all sites were prematurity with respiratory distress (CFR = 557), neonatal encephalopathy (CFR = 200) and neonatal sepsis (CFR = 119). However, a lack of preventative care was identified for mothers and newborns across these three sites. Low rates of adherence were seen in the administration of prophylactic antibiotics, administration of antenatal corticosteroids to mothers of neonates who were born before 34 weeks gestation, and number of antenatal care contacts (table 2). Conclusion Overall, indicators related to documentation had high coverage but may require contextualisation based on resource availability. Improvement in preventative newborn care in maternal health service in both countries can help reduce morbidity and complications at birth. References Perin J, Mulick A, Yeung D, et al. Global, regional, and national causes of under-5 mortality in 2000–19: An updated systematic analysis with implications for the sustainable development goals. The Lancet Child 6(2):106–15. WHO. Standards for improving the quality of care for small and sick newborns in Health Facilities; 2020. UN Children's Fund. Every newborn: An action plan to end preventable deaths Internet. World Health Organization; 2014. Heys M, Kesler E, Sassoon Y, et al. Development and implementation experience of a learning healthcare system for facility based newborn care in low resource settings: The neotree. Learning Health Systems. 2022;7(1).