Description % Age category 18-24years 39 25-29 years 30 >29years 31 Population group Black 35 Coloured 60 White and “other” 5 Obstetric info Intended pregnancy 37 Wanted pregnancy 78 Partner status In a relationship 90 Single 10 Living with partner Lives with partner 60 Lives separately from partner 40 Education level Grade 10 or below 40 > grade 10 60 Description % Employment type Unemployed 55 Informal 5 Formal 40 Individual income (monthly) R0 26 R1 – R1000 26 R1001 – R2000 17 R2001 – R5000 26 >R5000 5 Food insecurity Food insecure 42 Food insufficient 13 Asset index Least poor 28 Poor 24 Very poor 25 Poorest 23 Table 2: Sample descriptive Prevalence of Common Mental Disorders (antenatal) The prevalence of diagnosed mental health disorders among the pregnant women sampled were: 22% for Major Depressive Episode (MDE), 23% for any anxiety disorder, 9% for high and moderate suicidal risk level, and 18% current alcohol abuse and other drugs use (AOD) (Figure 1). Figure 1: Prevalence of Common Mental Disorders (antenatal) Many disorders were co-morbid. Twelve percent of the women had a comorbid MDE and any anxiety disorder, 6% for MDE and AODs use, and 6% for anxiety and AODs use. Five percent had MDE, any anxiety, and AODs use diagnosis (Figure 2). Figure 2: Comorbid mental illness diagnosis The prevalence of current suicidal ideation, for any risk level, was 23% using the MINI diagnostic tool. When suicidal ideation was disaggregated based on the risk levels, the prevalence of high risk suicidal ideation was 5%, 4% for medium risk, and 14% for low risk among the study population. Figure 3: Prevalence of any suicidal risk
the risk of mortality subsequent to hypothermia. We sought to describe the incidence of neonatal hypothermia and quantify the neonatal mortality and hypothermia association using the first temperature observed in the admission room of a busy Semi-rural unit in the Northern hot setting of Kwazulu- Natal province, South Africa. Material and Methods Clinical Facilities Empangeni Neonatal unit is part of a child and Maternal Hospital, Lower Umfolozi District War Memorial Hospital (LUDWMH) in North-East of Kwazulu-Natal, South Africa. This is the only maternity and neonatal regional referral Centre for an area with a population estimated at 2 Million with 16 District hospitals as referring entities. Fifty thousand (50 000) live births occur in the entire area annually including 10 000 at LUDWMH. The neonatal service was introduced at the hospital in 1998 with a 15 unit beds without intensive care facilities. Between 1999 and 2008 the unit was expanded to 92 bed neonatal units: 16 NICU beds, 40 high care, 16 special care beds and a Kangaroo mother care (KMC) unit (20 beds). Because of the burden in neonatal admissions needing mechanical ventilation, our NICU unit is set up to allow only 2.8 meters square around every infant bed which is below the provincial norms of 5 meters squares. Eight full time Paediatric and seven Obstetric consultants run the Paediatric and maternity & Gynecological services, respectively. Data collection A prospective, computerized data set of all routine neonatal admissions has been in place at LUDWMH since January 2000. This data base has been up graded to Epi-Info 7 software in January 2016. Additional information was added including admission temperature. On admission, at discharge and during the weekly neonatal morbidity and mortality review, standardized routine clinical and laboratory data on neonates are collected in a monthly edited admission book template compatible with CDC 7 locally designed data set. Data extracted include Date of admission, patient’s details, maternal details, demographics, presenting signs, admissions diagnosis, final and secondary diagnosis, treatment and procedures & complications, outcomes, date
The ABO blood groups of mothers and infants requiring EBT Maternal ABO blood groups against infant’s ABO blood groups and possible incompatibilities are shown in Table 2. The common ABO incompatible groups were mother O/infant B (30/57; 53%), mother O/ infant A (17/57; 30%) and mother B/infant A (4/57; 7%). Eighteen of the 57 (32%) infants who had ABO incompatible were Coomb positive, with 37% of the mother O/ infant B and 23% of mother O/ infant A having positive Coombs. Table 1: Rhesus blood group of mothers and infants receiving exchange blood transfusion Mothers Total Rh positive Rh negative Rh unknown Infant Rh positive 23 (9, 39%)* 8 (5, 62.5%)* 5 36 Rh negative 0 1 0 1 Rh not recorded 54 0 10 64 Total 77 9 15 101 * = Positive coombs Table 2. ABO blood groups of mothers and infants who received exchange blood transfusion Maternal ABO Blood Groups A B O AB Total Infant’s ABO Blood Group A 7 4$ (3, 75%)* 17$ (4, 23%)* 1 21$/ 29 (7/21, 33%) * B 1$ 4 (2, 50%) 30$ (11, 37%)* 0 31$/35 (11/31, 32%)* O 3 4 (1, 25%)* 5 0 0/12 AB 1$ 2$ 2$ 0 5$/5 Total 12 (15%) 14 (17%) 54 (67%) 1 (1%) 57$/81 (70%) (18/57, 32%)* $ - Number of patients with ABO incompatibility between mother and infant *- the number in parenthesis is a number and percent of patients with positive Coombs Mortality rate among the patients who received exchange blood transfusion A total of 6 patients died, a mortality rate of 6%. All deaths weighed >2000g and were outpatients (Table 6). Three had acute bilirubin encephalopathy on admission before exchange blood transfusion, two died from sepsis post exchange transfusion and one died
A monitoring and evaluation strategy is being developed, using the MCHN&N Dashboard indicators as a basis and exploring additional measures including audits and social development indicators. A number of partnerships non-governmental organisations and intersectoral collaborative projects are being explored, toward strengthening parenting and support for mothers within the first 1000 days of life (ranging from strengthening community worker programmes to offering parenting support to extending health departmental policy on providing support to breastfeeding women in the workplace to all other government departments), and includes collaboration with site-specific integrated service delivery models to strengthen referral pathways for service support for pregnant women with alcohol, substance abuse and smoking addictions, intimate partner violence/domestic abuse, and maternal psychosocal stressors and mental health problems. Figure 3 Conclusions High level recognition of, interest in and support for the 1st 1000days Initiative as an example of a transversal government initiative has been obtained. This has been a key enabler for improving the quality and scope of service delivery during pregnancy and the first two years of life at all levels. Senior provincial managers are now being held accountable to their respective institutional contributions to the First 1000 Days Initiative and related services via the performance management system. Although many related service components are being delivered, the opportunity now provides for the significance of these to be acknowledged and the quality improved. Many gaps have been identified and these are now being systematically addressed. Clinicians providing care for women before and during pregnancy and to infants and children during the first 2 years of life have a key leadership and advocacy role in advancing societal awareness and promoting shared responsibility for optimising the critical opportunity for optimal brain development during the 1st 1000 days of life toward addressing complex social issues.
babies who were born and nursed in the facility must be selected and audited by the auditing team. Provider Skills Assessments and Maternal interviews are conducted by members of assessing Team. INDICATORS ASSESSED Fifteen indicators were selected for this assessment. Input & Process Indicators Output Indicators Clinical audits HCP Skills assessments Maternal Interviews Infrastructure: Neonatal Unit Maternity Unit Resus Equipment Support Services Staffing Process Indicators: Statistics Systems Care assessment: Labour Ward Neonatal Unit PN Unit KMC Monitoring & Evaluation 4 clinical records: 2 Prem babies weighing 1500g & below 1x Sick Term 1xWell Well Term First examination of the newborn Neonatal resuscitation in the labour ward Neonatal resuscitation in the neonatal Nursery Kangaroo mother care Breastfeeding CPAP initiation Intubation (Regional Hospitals) Post natal ward X3 mothers Neonatal nursery X 2 mothers Critical Items to achieve a Silver Accreditation Critical Items to achieve a Gold Accreditation Critical Items to achieve a Platinum Accreditation Total score of 50% One indicator per category above 60% Dedicated MO that does not rotate for 6 months 50% non rotation of nursing staff Hand washing facilities are appropriate There is a functional resuscitaire and resuscitation trolley available in Labour ward Caesar theatre Neonatal nursery 100% of pre-term deliveries receive antenatal steroids Total score of 65% Eight indicators must be above 60% The Operational Nurse/Sister in charge has an appropriate qualification Hand spray at every bed 50% of maternity staff have received HBB training Functional nasal CPAP is available and used Record and infection audits are conducted monthly Total score of 80% Twelve indicators must score above 60% Numbers of nurses / shift meets the norms for beds beds correctly spaced with no overcrowding There are records of weekly HBB fire drills In and out surfactant therapy is available and used Clinical audits are conducted annually 10% institutional reduction targets in NMR, PCI and IHMR have been met Results: Results will be available by end of April 2016. Lessons learnt: Communication with the facility prior to the assessment makes the process run smoothly
related infections, medical/surgical conditions and acute collapse were much higher and, suggest that medical problems may need more focused attention. The study showed that the WHO near miss audit tool was an effective tool for measuring severe maternal morbidity and quality of care in the Metro West Maternity facilities. Near miss auditing was found to be feasible and ongoing routine audits would be valuable for the Metro West Maternity Services. This would require institutionalization of the Near Miss identification and monitoring systems.