title: Challenges and frugal remedies for lowering facility based neonatal mortality and morbidity: a comparative study.
abstract: Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one "control" were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.
authors.affiliation: Department of Bioengineering, Imperial College London, South Kensington Campus, SW7 2AZ, UK.
authors.forename: Hippolite O
authors.initials: HO
authors.lastname: Amadi
authors.affiliation: Departments of Community Health and Paediatrics, Lagos University Teaching Hospital, PMB 12003, Lagos 101001, Nigeria.
authors.forename: Akin O
authors.initials: AO
authors.lastname: Osibogun
authors.affiliation: Department of Paediatrics, University of Abuja Teaching Hospital, PMB 228, Abuja 900001, Nigeria.
authors.forename: Olateju
authors.initials: O
authors.lastname: Eyinade
authors.affiliation: Department Obstetrics and Gynaecology, Federal Medical Centre Nguru, Nguru 630001, Nigeria.
authors.forename: Mohammed B
authors.initials: MB
authors.lastname: Kawuwa
authors.affiliation: Federal Medical Centre Owerri, Owerri 460001, Nigeria.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Uwakwem
authors.affiliation: Department of Paediatrics, Federal Teaching Hospital Abakaliki, Abakaliki 480001, Nigeria.
authors.forename: Maryann U
authors.initials: MU
authors.lastname: Ibekwe
authors.affiliation: Department of Paediatrics, University of Abuja Teaching Hospital, PMB 228, Abuja 900001, Nigeria.
authors.forename: Peter
authors.initials: P
authors.lastname: Alabi
authors.affiliation: Departments of Community Health and Paediatrics, Lagos University Teaching Hospital, PMB 12003, Lagos 101001, Nigeria.
authors.forename: Chinyere
authors.initials: C
authors.lastname: Ezeaka
authors.affiliation: Federal Medical Centre Lokoja, Lokoja 260001, Nigeria.
authors.forename: Dada G
authors.initials: DG
authors.lastname: Eleshin
authors.affiliation: University of Benin Teaching Hospital, P.O. Box 1111, Benin-City 300001, Nigeria.
authors.forename: Mike O
authors.initials: MO
authors.lastname: Ibadin