Assessing Adherence to the World Health Organization’s Essential Newborn Care Guidelines amongst the Midwives in a District Hospital in Rwanda: A Descriptive study

BACKGROUND: Globally, every year 2.7 million newborns die within the first 28 days, with more than 80% of deaths occurring in low-resource countries. In 2016, 16 per 1000 neonates died in Rwanda, accounting for 36% of the total child mortality. The WHO’s Essential Newborn Care is a package consisting of chronological evidence-based practices that can help prevent up to 75% of neonatal mortality in low resource settings.
This study assesses the adherence to the Essential Newborn Care guidelines amongst midwives at Gakoma District Hospital in Rwanda. The results of this study hope to inform on appropriate interventions to improve the care and survival rate of neonates at the hospital.
METHODS: Direct observation was conducted to assess the Essential Newborn Care compliance at Gakoma District hospital using a checklist with 62 Essential Newborn Care criteria grouped into 16 categories in December 2018.
RESULTS: Compliance with Essential Newborn Care for 32 observed deliveries was 63.4%. The compliance rates for the 62 individual criteria ranged from 0% to 100%, with 24 (38.7%) criteria scoring compliance of 80% or higher. The compliance rates were highest for discharge care (96.1%), weighing the baby (92%), and documenting findings (91%). However, the compliance of completing immunization (0%), identification of the baby (19%), and thermal protection (25%) need improvement.
CONCLUSION: The overall level of compliance was lower than the recommended 80%. Stable provision of life-saving commodities in the birth unit and establishing a skin-to-skin contact schedule with proper communication and training to mothers about Essential Newborn Care is needed.