DOI: 10.5061/dryad.qrfj6q5jx
title: Availability and functionality of neontal care units in health facilities

description: Background Evidence shows that delivery of prompt and appropriate
 in-patient newborn care (IPNC) through health facility (HF)-based neonatal
 care and stabilization units (NCU/NSUs) reduce preventable newborn
 mortalities (NMs). This study investigated the HFs for the availability
 and performance of NCU/NSUs in providing quality IPNC, as well as an
 investigation of influencing factors in Mtwara region, Tanzania. Results
 About 70.6% (12/17) of surveyed HFs had at least one NCU/NSU room
 dedicated for delivery of IPNC, and 74.7% (3,600/4,819) of needy newborns
 were admitted/transferred in for management. Essential medicines such as
 tetracycline eye ointment was unavailable in 75% (3/4) of the district
 hospitals (DHs). A disparity existed between the availability and
 functioning of equipment including infant radiant warmers (92% vs 73%).
 Governance, support from implementing patterns (IPs), and access to
 healthcare commodities were identified from qualitative inquiries as
 factors influencing the establishment and running of NCUs/NSUs at the HFs
 in Mtwara region, Tanzania. Conclusion Despite the positive progress, the
 establishment and performance of NCUs/NSUs in providing quality IPNC in
 HFs in Mtwara has lagged behind the Tanzania neonatal care guideline
 standards, particularly after the IPs of newborn health interventions
 completed their terms in 2016. This study suggests additional improvement
 plans for Mtwara region and other comparable settings to optimize the
 provision of quality IPNC and lower avoidable NMs.
description: The study settings The study was conducted
 at 17 HFs that met inclusion criteria (operating for not less than three
 years also providing EmONC services) from among 36 HFs mandated to deliver
 IPNC in Mtwara region, Tanzania. Of all HFs included in the study, 76.5%
 (13/17) were public owned while 23.5% (4/17) were non-public. The majority
 64.7% (11/17) of study HFs were HCs, and 35.3% (6/17) were hospitals.
 Mtwara region is bordered on the north by the Lindi region, on the East by
 the Indian Ocean, on the South by Mozambique, and on the West by the
 Ruvuma region. It has a population of approximately 1,507,426 people
 (according to 2021 projections of the 2012 national census).
 Study design Quantitative data was collected
 and analyzed first to establish HF status on availability and
 functionality of NCUs/NSUs followed by qualitative data collection and
 analysis that obtained clarifications of the quantitative findings
 (33). Quantitative data was
 collected on HF-based newborn records and characteristics that allow for
 the delivery of quality IPNC such as;  newborn birth and death records,
 newborn admission and management records,  the availability and
 functioning of newborn care infrastructure and equipment, the availability
 of medicines and supplies, referral systems, recording and reporting
 systems, and evidence of newborn data use in decision making as well as
 healthcare staff training on in-patient newborn care. The investigation
 was guided by a framework for maternal and newborn care quality 
 (28,34). 
 Data collection
 The data was collected in three
 ways: 1) review of newborn records updated in health management
 information system (HMIS) and newborn registers from January to June 2021,
 2) health facility-based assessment of factors for delivery of IPNC
 services, and 3) interviews (IDIs and FGDs) with healthcare staff and
 managers to clarify the findings in 1 and 2. In the HF-based assessment, a
 standardized electronic checklist embedded in the tablets was used.
 Indicators for facility delivery of quality IPNC that were included in the
 checklist were extracted from the survive and thrive report
 (17), WHO-Early Essential Newborn
 Care (EENC) guideline (26), Tanzania neonatal care
 guideline (30), the WHO standards for
 improving quality of maternal and newborn care in HFs 
 (28), and the UNICEF tool kit for
 settling up special NCUs and NSUs (35). The HF-based assessment was done
 through an observational and interview schedule and verification. Two
 field investigators with prior experience in public health research were
 oriented for one day to conduct HF assessment and interviews. The data
 collection process was supervised by the principal investigator between
 June and August 2022. After preliminary analysis of
 quantitative data, outcomes within each HF indicator for delivery of
 quality IPNC were clarified through FGDs and IDIs. In-depth interviews
 were conducted with regional and council health managers having experience
 in newborn care and with some healthcare staff (midwives, nurses, and
 doctors) working in NCUs/NSUs at HFs that had less than two staff. Focus
 group discussions only involved healthcare staff (midwives, nurses, and
 doctors) working in NCUs/NSUs at the HFs that had at least two staff.
 Data management and
 analysis After being validated for
 completeness, quantitative data was exported to Stata version 14 for
 statistical analysis. Proportional means and overall scores were used to
 summarize the results, which were then displayed in tables for comparison.
 The primary outcome of the analysis was an HFs' availability and
 functionality of NCUs/NSUs. Recording audios for IDIs and FGDs from
 representative facilities (8 with and 4 without any form of NCU/NSU) were
 transcribed, read, and analyzed manually by 4 authors of this work.
 Contents describing each quantitative finding were manually summarized on
 a Microsoft Excel spreadsheet based on the similarity of responses from
 interviewees. Only important quotes from contents summarized in each
 quantitative finding were translated into the English language for
 reporting. <strong>Ethical approval and
 consent to participate </strong> Ethical approval for this study
 was obtained from the Ifakara Health Institute Ethical Review Board with
 permit <strong>No. IHI/IRB/No.22-2021</strong>. All
 participants provided written informed consent before they participated in
 the interviews.