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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 ?
