Table 2 Key quality of care gaps highlighted in the facility assessment
From: Assessing quality of newborn care at district facilities in Malawi
Infrastructure | • Lack of reliable electricity • Lack of soap and disinfectants |
Laboratory | • Blood gas analysis and blood cultures not available • Limited space |
Labour and delivery facilities | • Inadequate lighting • Limited space • Lack of sterile gloves • Lack of a heating source for neonates • Lack of equipment for neonatal resuscitation |
Caesarean section facilities | • Lack of a heating source for neonates • Lack of equipment for neonatal resuscitation |
Prevention and management of preterm labour | • Lack of protocols and guidelines on the management of preterm labour • Lack of records on preventing labour or antenatal administration of corticosteroid |
Nursery facilities | • Lack of running water, unclean toilets, patient access to handwashing stations • Understaffing |
Infection control | • Poor hand hygiene practice, lack of soap and disinfectants • Gloves sometimes used instead of hand hygiene • Infection control policies and routine disinfection of the premise were rarely practiced |
Supportive care of sick neonates | • Poor monitoring of neonates’ blood glucose |
Neonatal care equipment and supplies | • Lack of incubators, heated mattress cots, multi-function monitors and appropriately sized nasogastric tubes for preterm babies • Some oxygen concentrators and CPAP machines were not functioning and gaps in training on their use • Insufficient number of appropriate-sized self-inflating bags for resuscitation • Vancomycin, surfactant, sodium bicarbonate, chlorohexidine for cord care, vitamin D and IV calcium not available |
Routine neonatal care | • Newborn assessments not completed • Irregular monitoring of newborns’ breathing and temperatures • Poor documentation |
Case management of the sick newborn | • Lack of guidelines for management of convulsions and jaundice • Lack of blood and urine cultures for neonatal sepsis diagnosis • Feeding sick neonates were not recorded or monitored routinely |
Monitoring and follow-up of sick newborns | • Poor reassessment by physicians |