Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted. The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care). The continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0). The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

中文翻译：

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在马拉维的地区设施中评估新生儿护理的质量

马拉维是撒哈拉以南非洲为数不多的实现1990年至2015年间将五岁以下儿童死亡率降低三分之二的千年发展目标的国家之一。但是，在这一年龄段，新生儿死亡率下降的速度最慢，即使设施出生率正在增加。保证在大多数分娩发生的地区级机构检查新生儿护理质量。本文的目的是评估马拉维南部三所地区医院和一个初级保健中心的新生儿护理质量，并报告使用世卫组织综合护理质量评估工具的局限性和经验教训。这些设施评估是“为马拉维整合新生儿保健软件包”项目的一部分，是“创新的非洲孕产妇和儿童健康”计划的一部分。世卫组织综合护理质量评估工具用于评估护理质量，供应和资源的数量以及数量。其中包括有关基础设施，新生儿护理以及人工和分娩的模块。2017年11月进行了设施评估，并按Likert量表从1到5对护理方面进行了评分（5分表示符合WHO的护理标准; 1分表示最低是指护理不足）。对分娩，分娩和新生儿护理的连续性进行了评估，以确定需要改进以达到护理标准的领域。需要改进的关键领域包括感染控制（平均得分2.9），劳务病房（2.3），手术室（3.3）的设备，用品和新生儿护理设置，和托儿所（3.4个托儿所，3.0个用品和设备），以及生病新生儿的管理（3.2个），监测和随访（3.6个）。在12个领域中，实验室中只有一个满足护理标准，仅需进行少量改进（4.0）。世卫组织综合护理质量评估工具是一种经过验证的工具，可以揭示地区级卫生机构所面临的复杂护理质量挑战。结果表明，护理质量需要提高，特别是对于患病和脆弱的新生儿。世卫组织综合护理质量评估工具是一种经过验证的工具，可以揭示地区级卫生机构所面临的复杂护理质量挑战。结果表明，护理质量需要提高，特别是对于患病和脆弱的新生儿。世卫组织综合护理质量评估工具是一种经过验证的工具，可以揭示地区级卫生机构所面临的复杂护理质量挑战。结果表明，护理质量需要提高，特别是对于患病和脆弱的新生儿。