Objectives: To study the scalability of the rural hospital (RH) model of basic newborn care in a general hospital (GH) by including very low birth weight (VLBW) infants, and to assess the implementation aspects.
Study design: Observational
Settings: RH (1988-1992) and General Hospital, (GH) (2010-2013).
Subjects: VLBW infants with birth weight ranging from 1000 g to 1500 g.
Interventions: (1) RH: Basic care including warmth, feeding, antibiotics, and oxygen (2) GH: Basic plus circulatory care (2010-12), and continuous positive airway pressure (CPAP) support (2013). Mechanical ventilation and surfactant therapy were not available.
Main outcome measure: Mortality
Results: The cumulative mortality (38.5%) with basic neonatal care in the RH model declined to 26.6% at the GH with the addition of circulatory support and a “home-made” CPAP system.
Conclusions: The RH package may be scaled up by adding CPAP and circulatory support to reduce the mortality among VLBW infants. The RH model is scalable horizontally and vertically.
What is already known about this subject?
- Implementation research constitutes a relatively new and underdeveloped field,
- One of the facets of health system research is the implementation research.
- Implementation research aims at bridging the gaps between knowledge and action.
What does this study add?
- Tertiary care center can help in developing basic newborn care at a rural hospital.
- The rural hospital model can be upscaled vertically as well as horizontally.
- Addition of circulatory support and CPAP to basic newborn care can significantly lower neonatal mortality.
How might it impact on clinical practice in the foreseeable future?
The study may encourage tertiary care centers to facilitate the development of basic newborn care centers at the rural hospitals. These centers, in turn, can spread horizontally.
UNICEF. Levels & Trends in Child Mortality: Report; p. 201, 2017.
Borulkar PD, Borulkar SP, Dhole RK, Daga SR. Special care for newborns at a community hospital: a 5-year experience. Tropical Doctor. 1998; 28(4): 201-203.
Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013: 347.
Daga S, Mhatre S, Borhade A, Khan D. (2014). Home-made continuous positive airways pressure device may reduce mortality in neonates with respiratory distress in low-resource setting. Journal of Tropical Pediatrics. 2014; 60(5): 343-347.
Daga BS, Joshi H, Gunjal P, Mhatre S. An innovative air-oxygen blender for continuous positive airway pressure support in resource-poor locations: A feasibility study. Journal of Tropical Pediatrics. 2017; 63(4): 269-273.6.
Bahl R, Martines J, Bhandari N, Biloglav Z, Edmond K, Iyengar S, et al. Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015. Journal of Global Health. 2017; 2(1): 7.
World Health Organization. Safe Motherhood. Thermal Control of the Newborn: a practicalguide.[Internet] 1993. Available from: https://www.who.int/maternal_child_adolescent/documents/ws42097th/en/.
Daga S, Naktode N, Borade A, Gawali S. Introducing donor Milk in a neonatal intensive care unit: a developing Country’s perspective. The Indian Journal of Pediatrics. 2016; 83(10): 1121-1124.
Daga S, Daga A, Mhatre S, Ghane V. Enhancing neonatal survival: what can we do today? Journal of Perinatology. 2016; 36(8): 681-684.
Kamath BD, MacGuire MSW, Mc Clure EM. Neonatal mortality from respiratory distress syndrome: Lessons for low-resource countries. Pediatrics. 2011; 127: 1139–1146.
Martin S, Duke T, Davis P. Efficacy and safety of bubble CPAP in neonatal care in low- and middle-income countries: a systematic review. Archieves of Disease in Childhood Fetal Neonatal Ed. 2014; 99: F495–504.
Peters DH, Tran NT, Adam T. Implementation research in health: a practical guide. World Health Organization. 2013.
Sanders D, Haines A. Implementation research is needed to achieve international health goals. PLoS Med. 2006; 3: e186.
Theobald S, Brandes N, Gyapong M, El-Saharty S, Proctor E, Diaz T, et al. Implementation research: new imperatives and opportunities in global health. The Lancet. 2018; 392(10160): 2214-2228.