Efficacy of a Discharge Checklist for Neonates in Reducing Neonatalmorbidity and Mortality

Abstract

Of the estimated 5.9 million child deaths in 2015, almost 1 million occurred in the first day of life while about 2 million deaths occurred in the first week. Most of these deaths are readily preventable or treatable with proven, cost-effective interventions. The checklist can act as a tool to reduce neonatal morbidity and mortality. Objective: The primary objective was to determine the impact of introducing a standardized neonatal discharge checklist on the rate of hospitalization during the neonatal period at the Kenyatta National Hospital. The secondary objective was to determine the acceptability of a structured postnatal discharge checklist among health care workers at Kenyatta National Hospital. Study design setting and population: a mixed method study that included the Quasi experimental pre- post intervention design and focus group discussion was carried out in the post- natal wards at Kenyatta National Hospital, which is the main referral hospital. Neonates with no complications awaiting discharge were enrolled for the study after consent was obtained. Methodology: Qualitative and quantitative methods were incorporated in this study. Structured questionnaires were administered to both the mothers in the postnatal ward and the trained nurses on the checklist for the danger signs of newborns, breastfeeding, immunization and the use of chlorhexidine in cleaning the umbilical stump. Qualitative data was obtained using focus group discussions. Results: Hospitalization rates were 7.4% and 3.2 % in the pre intervention and post intervention periods respectively. There was significant improvement in knowledge on cord cleaning after the intervention (p =<0.001) as well as on identifying newborn danger signs (p=0.005). There was a trend noted for reduced hospitalization following introduction of the neonatal discharge checklist. Conclusion: There was a trend for reduced hospitalization following implementation of the neonatal discharge checklist. Acceptability of the discharge checklist was appreciated by health care workers while a call for collaboration with the paediatric department was emphasized.