Dr. Farah Fatupaito PRSH Conference Samoa 2013

Challenges in neonatal care

in SamoaDr. Farah Fatupaito

PRSH ConferenceSamoa 2013

2 main- Upolu1 main Savaii8 district hospitalsExperienced Midwives in each hospital

All sick newborns referred to Tupua Tamasese Meaole Hospital

Hospitals in Samoa

Faafetai

neonatal health issues Mortality rates Progress to achieving MDGs of reducing

child mortality Strategies to achieving MDG 4 Challenges and opportunities to improve

services

outline

Priority child health issues in Samoa

Respiratory tract infectionsAcute gastroenteritisLow birth weight babies and congenital abnormalities

MalnutritionRheumatic fever Iron deficiency anemiaBreast feeding Immunization coverage

Key issues in child health

1 Pneumonia

2 Acute bronchiolitis

3 Acute gastroenteritis

4 Typhoid fevers

5 Infections of the skin/ subcutaneous tissues

6 Injuries , wounds , fractures , poisoning

7 Aspiration syndromes ( meconium )

8 Bacterial sepsis of the newborn

9 prematurity / Low birth rates

10 Asphyxia / fetal distress

10 leading causes of hospital morbidity 0-13 years FY 07/08

Total number of admissions to NNU

2009 - 823 2010 - 911 2011 - 806 2013 - 1020

Number of deliveries at TTM

2009- 3490 2010 -

3057 2011 -

3972 2012 -

4012

2009 2010 2011 20130

200

400

600

800

1000

1200

total number of admissions to NNU

number

low bwt21%

home del3%

MSAF11%

MAS5%

as-phyxia

4%

big babies8%

twins3%

cong abn2%

csect42%

Admission by disease to NNU (%) 2011

Home delivery3%

Twins 3%

Big babies8%

LBW17%

Meconium aspiration

4%MSAF13%

Asphyxia6%

C-Section45%

Abnormal Babies2%

admission to NNU by disease (%)2012

2009 2010 2011 20120

20

40

60

80

100

120

140

160

180

128

137

150

171

total number of low birth weight babies per year

2009 2010 2011 20120

20

40

60

80

100

120

140

low birth weight over 4 years

LBW

VLBW

ELBW

total number

Conditions

RESUSCITATION FLUID AND ELECTROLYTE mx Prevention and treatment of INFECTION Long stays in NNU

MANAGEMENT of complications

0

50

100

150

200

250

Series3MAS

Rates 2009- 5% 2010- 6.8% 2011- 3% 2013-4%

Meconium stained liguor

Years preceding SDHS

Neonatal mortality

Postneonatal mortality

Infant mortality

Child mortality

Under five mortality

0-4 5 5 9 6 15

5-9 6 3 9 4 13

10-14

5 3 8 4 12Source :Samoa Demographic

Survey

Infant and childhood mortality rates

Years preceding SDHS

Neonatal mortality

Postneonatal mortality

Infant mortality

Child mortality

Under five mortality

0-4 5 5 9 6 15

5-9 6 3 9 4 13

10-14 5 3 8 4 12

Source :Samoa Demographic Survey

Infant and childhood mortality rates

Samoa Tonga Fiji Tuvalu Kiribati PNG Solomon Is micronesia

8 8 8 14 19 23 11 17

Neonatal mortality Rates 2011

MDGs at a glance for Samoa

Goal 4: Reduce child mortality TARGET Reduce child

mortality by 2/3 between 1990 and 2015

INDICATORSUnder five mortality

ratesInfant mortality ratesProportion of 1 year old

children immunised against measles

Strategies that work

Seven essential service Package for child survival

• Skilled attendance during pregnancy, delivery and immediate postpartum • Care of the newborn • Breastfeeding and complementary feeding • Micronutrient supplementation • Immunization of children and mothers • Integrated management of sick children

4

Bubble CPAP 2009- improve survival rates in LBW

POINTS training for nurses 2012-2013 Protocols Visiting Neonatologist Specialists Medicines eg. surfactant, probiotics, Newborn screening tests Annual neonatal resuscitation courses

Innovations to improve outcome

Prematurity and complications

Meconium Big babies Congenital

abnormalities Home deliveries

Staff turnovers Need for specialisation

in neonatal nursing Early referrals from

TBA Continuous training-

Newborn resus/care Better antenatal care Equipments for new

hosp? research

Ongoing challenges

What would this world be without children ?