title: Reduced neonatal mortality in a regional hospital in Mozambique linked to a Quality Improvement intervention.
abstract: Neonatal mortality remains a serious health issue especially in low resource countries, where 99% of neonatal deaths occur. Doctors with Africa CUAMM is an Italian non-governmental organization in the field of healthcare that has been working in Africa since 1955. In Mozambique, at the Central Beira Hospital (CBH), it has a project with the aim of supporting the neonatal intensive care unit (NICU) and the Obstetrical Department of the CBH through a multi-level intervention. Our aim was to evaluate the effectiveness of CUAMM continuous Quality Improvement intervention in terms of reduction of the overall neonatal mortality rate in the NICU of CBH.
  
  
  
  A baseline analysis was performed in order to assess the actual standard of neonatal care. Subsequently, the intervention was focused on three main areas: infrastructure, equipment and clinical protocols improvement. A retrospective pre- (2013)/post- (2014) implementation analysis of clinical outcomes was performed.
  
  
  
  Total population included 4,276 newborns, 2,118 (50%) born in 2013 and 2158 (50%) born after implementation. Baseline characteristics of the two groups were similar apart from a higher incidence of outborn neonates (33% vs 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 asphyxia (22% vs 30%), sepsis (4% vs 7%) and prematurity (18% vs 28%) increased between the two study period. Mortality rate for each of these causes decreased from before to after the implementation: asphyxia (34% vs 19%, p < 0.01), sepsis (39% vs 28%, p = 0.06) and prematurity (43% vs 33%, p < 0.01).
  
  
  
  We found a reduction in mortality rate among newborns admitted to CBH's NICU after the first year of CUAMM intervention. Most of this reduction can be attributed to the decrease in deaths for asphyxia, sepsis and prematurity. A Quality Improvement intervention based on infrastructural, equipment and clinical objectives was associated with a reduction of neonatal mortality rate in a low-resource NICU.
authors.affiliation: Doctors with Africa CUAMM, Padova, Italy. mecavicchiolo@gmail.com.|Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy. mecavicchiolo@gmail.com.
authors.forename: Maria Elena
authors.identifier: 0000-0002-9965-6549
authors.initials: ME
authors.lastname: Cavicchiolo
authors.affiliation: Doctors with Africa CUAMM, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Lanzoni
authors.affiliation: Central Hospital of Beira, Beira, Mozambique.
authors.forename: Mazungo Olivier
authors.initials: MO
authors.lastname: Wingi
authors.affiliation: Doctors with Africa CUAMM, Padova, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Pizzol
authors.affiliation: Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Daverio
authors.affiliation: Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy.
authors.forename: Liviana
authors.initials: L
authors.lastname: Da Dalt
authors.affiliation: Doctors with Africa CUAMM, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.affiliation: Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Trevisanuto
mesh_terms: D001034:Apgar Score; D005260:Female; D006760:Hospitalization / Q000639:trends; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards / Q000706:statistics & numerical data*; D009073:Mozambique / Q000453:epidemiology; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D047928:Premature Birth / Q000401:mortality; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality
keywords: Low resource setting; NGO; Neonatal mortality; Quality improvement