Skip to main content

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