Transcript Conservative treatment of fresh obstetric fistula by early

Low-tech, high impact:
Care for premature neonates in a
district hospital in Burundi
Brigitte Ndelema, Tony Reid, Rafael Van den Bergh, Marcel Manzi,
Wilma van den Boogaard, Rose J. Kosgei, Isabel Zuniga, Manirampa
Juvenal and Anthony D. Harries
Médecins Sans Frontières (MSF), Burundi, Brussels
Burundi - Context
● Small landlocked
country in Central
Africa
● ~ 10 million people
● Maternal mortality
200x higher than in
Norway
● Neonatal mortality
20x higher than in
Belgium
● 30% home deliveries
Burundi - MSF
MSF in Kabezi, Burundi:
- Emergency obstetrics
- Neonatal Intensive
Care Unit
- Kangaroo Mother Care
Study rationale

Death among Prematures is a major contributor
to neonatal mortality and overall under five
mortality

Neonatal care is often restricted to centralised
and tertiary level facilities

Decentralisation of care is recommended (‘Born
Too Soon’ study group), but models of care have
not been piloted nor described
Objective
To describe characteristics and treatment
outcomes of premature neonates admitted to a
district hospital in rural Burundi.
Low technology - neonatal intensive care
Non-specialist
staff (general
practitioners and
nurses) being
trained in
neonatology
Low technology - neonatal intensive care
Pulse –
Oxymeters
Low technology neonatal special care
Electronic IV pump
Low technology - neonatal intensive care
Oxygen concentrators for oxygen therapy
Kangaroo Mother Care
Breastfeeding
Keeping warm
Admission criteria for prematures

Neonatal Intensive Care Unit



Very preterm neonates (<32 weeks gestation)
Moderately preterm neonates (32 to 36 weeks), if
together with pathology
Kangaroo Mother Care

Moderately preterm neonates, if low birth weight
(< 2000 g) and no pathology
Methods

Design:
Retrospective analysis of programme data

Period:
January 2011 – December 2012

Setting:
Kabezi District Hospital (rural)

Study population:
All neonates born at less than 37 weeks
and admitted

Ethics Approval:
National Ethics Committee in Burundi and
MSF Ethics Review Board.
Clinical conditions at birth
Premature infants
< 32 weeks of gestation
N=134 (%)
32-36 weeks of gestation
N=236 (%)
Birth weight (g)
< 1000
17 (13)
1
61 (46)
33 (14)
47 (35)
4 (3)
5 (4)
181 (77)
14 (6)
7 (3)
54 (40)
74 (55)
6 (5)
107 (80)
71 (30)
151 (64)
14 (6)
151 (64)
39
20
7
1
0
57
81
25
8
13
1
81
1000-1499
1500-2499
>2500
Not recorded
APGAR score at 5 minutes
0-6
7-10
Not recorded
Active birth resuscitation
Antenatal maternal complications
Prolonged/obstructed labour
Ante-partum haemorrhage
Sepsis
(Pre-)eclampsia
Uterine rupture
Other severe conditions
(29)
(15)
(5)
(1)
(43)
(0.4)
(34)
(11)
(3)
(6)
(0.4)
(34)
Length of Stay in days

Medians (Inter Quartile Ranges)


< 32 weeks of gestation:
11 (5 – 22)
32 – 36 weeks of gestation: 9 (4 – 16)
Discharge outcomes – stratified by
gestational age
« Born too soon »
Discharge outcomes – stratified by
birth weight
Discussion

Good outcomes achieved, even for very premature/very
low birth weight babies. This compares well with the
“Born too Soon” study group

Possible reasons:




Strong focus on standardised protocols
Training for non-specialised people (allowed task-sharing)
Complete integration of maternal and neonatal services
Integrated neonatal and Kangaroo care
Conclusions

It is feasible to provide intensive neonatal care for
premature neonates at a district level in Africa

Extremely premature/extremely low birth weight babies
should not be excluded

Good outcomes were achieved with low tech resources,
suggesting that this model of neonatal care could be a
way forward to reduce neonatal, and paediatric mortality
in low-income settings
Acknowledgement

We thank all patients, the MSF Kabezi team, our partners and the
Ministry of Health

This research was part of the Structured Operational Research and
Training Initiative (SORT IT) in Africa - a global partnership of the
WHO and led by the Operational Research Unit (LUXOR), Médecins
Sans Frontières, OCB- Luxembourg; the Centre for Operational
Research, The International Union Against TB and Lung Disease,
the Centre for international health, University of Bergen, Norway
and the Institute of tropical Medicine Antwerp