title: Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania.
abstract: BACKGROUND
  Every year, more than a million of the world's newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities - for example, improving steps to help newborns breathe at birth - have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation.
  
  
  METHODS
  Cross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care.
  
  
  RESULTS
  Index scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities.
  
  
  CONCLUSIONS
  Within two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania.
authors.affiliation: Jhpiego Tanzania, PO Box 9170, Dar es Salaam, Tanzania. Christina.makene@jhpiego.org.
authors.forename: Christina Lulu
authors.initials: CL
authors.lastname: Makene
authors.affiliation: Jhpiego Tanzania, PO Box 9170, Dar es Salaam, Tanzania. Marya.plotkin@jhpiego.org.
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.affiliation: Jhpiego Baltimore, Baltimore, MD, USA. sheena.currie@jhpiego.org.
authors.forename: Sheena
authors.initials: S
authors.lastname: Currie
authors.affiliation: Jhpiego Tanzania, PO Box 9170, Dar es Salaam, Tanzania. Dunstan.Bishanga@jhpiego.org.
authors.forename: Dunstan
authors.initials: D
authors.lastname: Bishanga
authors.affiliation: Departments of Pediatrics and Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. tamiugwi@gmail.com.
authors.forename: Patience
authors.initials: P
authors.lastname: Ugwi
authors.affiliation: Departments of Pediatrics and Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. henrygj24@gmail.com.
authors.forename: Henry
authors.initials: H
authors.lastname: Louis
authors.affiliation: Tanzania Ministry of Health and Social Welfare, Dar es Salaam, Tanzania. Kwinani1977@gmail.com.
authors.forename: Kiholeth
authors.initials: K
authors.lastname: Winani
authors.affiliation: Departments of Pediatrics and Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. brett.d.nelson@gmail.com.|Harvard Medical School, Boston, MA, USA. brett.d.nelson@gmail.com.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004865:Equipment and Supplies, Hospital; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D018743:Perinatal Care / Q000592:standards*; D010564:Personnel, Hospital / Q000592:standards*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012151:Resuscitation / Q000193:education / Q000592:standards*; D013636:Tanzania