Conference abstract

Malakal community neonatal care strategy

Pan African Medical Journal - Conference Proceedings. 2018:9(16).13 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.16.743

Contact the corresponding author
Keywords: Community-based approach, neonatal care, community health worker, home visit, neonatal mortality, South Sudan

Malakal community neonatal care strategy

Inmaculada Carreras1,&, Carmen Terradillos1, Elena Grandío2, Miriam Steinsto3, Azuma Simon3, Christina John3, Juliana Othow3, Aliza Joseph3, Martín Sosa4, Aziz Harouna2, Mohamed Eltom Hamid5, Nadia Lafferty6

1PMR, South Sudan, OCBA, Malakal, South Sudan, 2MedCo, OCBA, Malakal, South Sudan, 3IECHP, OCBA, Malakal, South Sudan, 4Dep MedCo, OCBA, Malakal, South Sudan, 5OCBA, Nairobi, 6OCBA, Barcelona, Spain

&Corresponding author
Inmaculada Carreras, PMR, OCBA, Malakal, South Sudan


Introduction: most neonatal deaths occur within the first week of life. In order to reduce neonatal mortality in low and middle-income countries, World Health Organization (WHO) has proposed an action plan promoting home follow-up of neonates in the early days after birth. This WHO program has been recently implemented in Malakal’s protection of civilians site in South Sudan. The aim of this study is to present preliminary data on changes in health indicators after implementation of this initiative.

Methods: the strategy was set up by defining human and logistic requirements and by drawing up a data collection checklist. MSF medical team performed a 20-hour training to Community Health Workers (CHW). Home visits were scheduled at days 1, 3 and 7 after birth. Feeding, weight and the presence of danger signs were assessed. If any abnormality was detected, the newborn was transferred to our hospital. Total admissions, number referrals and presence of danger signs were recorded. Mortality rate (inpatient department (IPD) and community) was measured.

Results: 253 newborns were followed-up by CHW within the first 15 weeks of the program. 38 (15%) were referred to hospital due to the presence of danger signs: fever (n = 32), reduced responsiveness (n = 22), inability to feed (n = 11), breathing difficulty (n = 5), seizures (n = 2). 18 of them were admitted. Five home deliveries (1.9% of total newborns) and one reported neonatal death were detected during home visits. IPD neonatal mortality rate decreased from 4.5% to 3.1%. No neonatal deaths were found in the community after the first week of this strategy.

Conclusion: our preliminary results show that the WHO neonatal home follow-up plan can be implemented in resource-limited settings, and that a CHW home-visit care model could improve neonatal health indicators through early detection of danger signs. More data is required to verify that the improvement in IPD neonatal mortality is linked to the implementation of this strategy and is sustained. Malakal’s experience might eventually be generalized to similar environments.