ArticleBMC pediatrics2021
Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda.
Article in BMC pediatrics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 14 citations in OpenAlex.
- Health interventions and stakeholder roles in neonatal mortality reduction within low-income countries: A scoping review.Public health in practice (Oxford, England) · 2026Review
- Nurses' and Midwives' Experiences of Participating as Mentees in a Clinical Mentorship Program in Rwanda: Benefits and Challenges.Rwanda journal of medicine and health sciences · 2026Article
- Establishing core competencies for neonatology fellowship training in Syria: a modified Delphi study approach.BMC medical education · 2025Article
- Developing and piloting a peer quality improvement coaching protocol for front-line healthcare staff.BMJ open quality · 2025Article
- Do we need a new global policy for ending preventable perinatal deaths in fragile low-income countries?Journal of global health · 2023Article
- Defining the Current Deployment of Neonatal Infusion Pumps in Low- and Lower-Middle-Income Countries: A Rapid Review.Global pediatric health · 2023Review
- Do we need a new global policy for ending preventable perinatal deaths in fragile low-income countries?Journal of global health · 2022Article
- Implementing value-based healthcare using a digital health exchange platform to improve pregnancy and childbirth outcomes in urban and rural Kenya.Frontiers in public health · 2022Article
- Every breath counts: Lessons learned in developing a training NICU in Northern Tanzania.Frontiers in pediatrics · 2022Article
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNeonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes.
methodsA pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests.
resultsNCUs were run by a median of 1 nurse [interquartile range (IQR):1-2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77-155] to 137 [IQR: 79-184]. Availability of advanced equipment improved (syringe pumps: 57-100 %, vital sign monitors: 51-100 % and CPAP machine: 14-100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001).
conclusionsThe ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.
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