Establishment of a neonatal nursery in a rural district hospital in Malawi: A retrospective review of neonatal outcomes in Neno District Hospital (2014 - 2021)

Abstract

Abstract Background: Despite efforts to improve neonatal care worldwide, neonatal mortality rates in sub-Saharan Africa,including in Malawi, remain high, with a need for space, equipment, and staff. We evaluated the impact of establishing a district-level neonatal nursery and subsequent strengthening efforts over seven years at Neno District Hospital, Malawi. Methods: We conducted a retrospective cohort study to measure the neonatal outcomes before nursery establishment (study period I, 2014-2015), following the establishment of a nursery (study period II, 2016-2018), and ongoing strengthening efforts (study period III, 2019-2021). We extracted data from neonatal registers and employed descriptive statistics and chi-square tests to compare the overall neonatal outcomes between admission periods. We then performed logistic regression to isolate factors associated with neonates alive atdischarge from the neonatal nursery. Results: In a review of nursery capacity, nursery establishment in 2016 included initial inputs of equipment, medications, and systems with increased support of space, human resources, and additional systems with the transition to a larger nursery in 2019. Of the 1366 neonates observed over the entire study period (2014-2021), the three primary admission diagnoses were birth asphyxia (30%, n=411), sepsis (29%, n=396), and prematurity (21%, n=286). The proportion of neonates discharged alive increased from 62% to 74% to 88% in study periods I, II, and III, respectively. The odds of being discharged alive were four times higher in study period III than in study period I (OR=4.34; 95% CI: 2.6-7.04; p<0.001) and increased sixfold after adjusting for sex (aOR=6.51; 95% CI: 3.69-11.5; p<0.001). Neonates admitted with prematurity were less likelyto be discharged alive (OR=0.56; 95% CI: 0.38-0.82; p=0.003) than other diagnoses. The odds of being discharged alive for neonates weighing 1500-2500 g were five times higher than those weighing <= 1500 g at birth (aOR=5.25, 95% CI=2.61-10.7, p<0.001). Conclusions: Neonatal nursery services and outcomes improved with nursery establishment at Neno District Hospital and improved with increased inputs over seven years. A multidimensionaldecentralized approach at a district hospital with adequate space, staff, equipment, and medications is vital to treating sick neonates and decreasing neonatal mortality.