NEONATAL CARE REPORT | UNICEF AND WHO | DOWNLOAD

 Ministry of Health, Community Development, Gender, Elderly and Children, the Newborn and Child Health Unit in collaboration with partners, developed this consolidated national guideline, which summarises key areas from the above-mentioned independent training packages. � e guideline will be available all over the country, at all levels of health care, used by health care providers as a reference book for neonatal care. Depending on the availability of resources, the national level capacity will advocate, disseminate and build regional capacity for smooth implementation to the councils and health facility level, and collaborate with the regional and district health management authorities to scale up the guidelines. � e guideline is comprised of � ve chapters, summarized below:

 

Chapter 1: Essential Newborn Care (ENC): Essential Newborn Care (ENC) is care that every newborn baby needs regardless of where it is born or its size. Essential Newborn Care should be applied immediately a� er the baby is born and continued for at least the � rst 7 days a� er birth. � is chapter aims to ensure health workers have the knowledge to provide appropriate care at the most vulnerable period in a newborn’s life. � e chapter focuses on; Infection Prevention and Control, Preparation for birth, Essential Newborn Care in the � rst 24 hours, Immediate Care a� er birth and Essential Care for Every newborn.

 

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Chapter 2: Care of Pre-term and Low birth Weight Newborns (LBW): � e World Health Organization (WHO) has de� ned low birth weight (LBW), as the weight at birth less than 2500g. Low Birth Weight can be a consequence of preterm birth (de� ned as birth before 37 completed weeks of gestation), or due to small size for gestational age (SGA, de� ned as weight for gestation < 10th percentile), or both. � e LBW infants are at higher risk of early growth retardation, infections, developmental delay, impaired respiration, di� culty in feeding, poor body temperature regulation and death during infancy and childhood. � is chapter describes; Prevention and Management of LBW Newborns, Care of LBW, Feeding and Fluid Management, � ermal protection, Management of Common complications in LBW new-borns, Discharge and Follow up.

 

Chapter 3: Care of the Sick Neonates: � e most common causes of neonatal deaths are preterm birth complications, newborn infections and birth asphyxia. A newborn baby who is born preterm or has a potentially life-threatening problem is in an emergency situation requiring immediate diagnosis and management. Delay in identi� cation of the problem or in providing the correct management may be fatal. When a health care provider receives a sick newborn, there is a need to follow some basic steps of triaging and categorizing into: Newborn in a serious condition, Life�threating or, Stable condition.is chapter therefore focuses on the; Assessment for Emergency signs and management, outpatient management, admission and referral management, General considerations, management of speci� c conditions, management of a newborn delivered by a mother with infections, birth injuries and management of congenital anomalies.

 

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Chapter 4: Care for Child Development and Growth Monitoring: Development during the early years lays the critical foundations for health, learning and behaviour across the life course, and it has an impact on health and well-being evenof the next generation. In this period from pregnancy to age of 3 years, children are most susceptible to environmental in� uences and experiences during the � rst years with their families and other caregivers greatly a� ect the child’s whole life. Poor development during childhood, unfortunately, is widespread. � ese disadvantaged children do poorly in school and subsequently have low incomes, and provide poor care for their own children. � e chapter focus on Nurturing Care for Early Childhood Development, Care for Child Development during Pregnancy, Home Care for Child Development a� er Delivery, Care for Child Development for the Hospitalized New-born, Growth Monitoring, Counselling and Follow-up visits.

 

Chapter 5: Establishing Neonatal Care Unit (NCU): A facility is considered to have neonatal care unit if has; general neonatal ward to care for sick neonates, Kangaroo Mother Care for Pre-term and Low birth weight, High Dependency Unit or Intensive Care Unit for critically sick neonates and Isolation room for contagious cases. � is chapter therefore, provides guidance on how to establish Neonatal Care Units (NCUs), aiming at supporting and facilitating the planning, establishment, operationalization and monitoring of NCUs at various levels of health care. It is mainly focusing on the requirements, speci� cations and processes related to establishment of NCUs. All Districts, Regional Hospitals and all higher�level hospitals are required to have a full functioning Neonatal Care Unit. Moreover, admitting health centres should have a general neonatal ward to provide stabilization and care for the small and sick neonates before discharge or referral to higher-level facilities.

 

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Dissemination of the guideline: � e dissemination of this guideline to the regions will be e� ected through one-day advocacy to RHMTs and CHMTs members to update them on the guideline and importance of establishing functional neonatal care units in the admitting health facilities. � e next three days will be used for orientation of facility in-charges from health facilities at Regional and Council level. � is dissemination � ow, intends to build capacity at Regional and Council management to plan, organise and coordinate the 3 days orientation training to service providers from health facilities in the Councils during the scale up. � e regional and council capacity also will have duty to conduct supportive supervision and mentorship to improve and monitor implementation of the guideline in their corresponding health facilities.

 

However, in situation where resources are scarce and the 3 days orientation trainings are not feasible, service providers should make a self-reading and reference to the contents available in this document to update themselves on the current neonatal care

 

 

 

The Kingdom of Eswatini is a lower middle-income country with an estimated population of approximately 1.1 million people (Population Census 2017). The fertility rate is 3.14 children per woman of childbearing age. The proportion of births attended by skilled personnel is approximately 88% (MICS 2014), with a neonatal mortality rate of 20 deaths per 1,000 live births (compared to the infant mortality rate of 85 deaths per 1,000 live births). In 2016, neonatal deaths ranked 12th in the list of childhood mortality in Swaziland and ranked 6th of all causes of years of life lost in 2016. Preterm births composed about 1 out of 9 births and ranked 7th of all causes of death and disability combined in Eswatini.

 

Given the large number of newborn babies born to mothers in Eswatini, combined with the limitation of resources, the Kingdom of Eswatini mobilized partners through the Ministry of Health, in cooperation with UNICEF and WHO, to systematically provide evidence-based, high-quality standards of care to ensure the health of newborns born in the country in an attempt to meet the Sustainable Development Goals. It is from this desire for better care for the babies of Eswatini that the first-ever Kingdom of Eswatini Neonatal Care Clinical Guidelines were developed. The guidelines are the collection of global best practices that are modified for the practical use by all healthcare workers and healthcare facilities in Eswatini.

 

The guidelines also include a quick reference section for readily-available retrieval of important neonatal care instruction for healthcare workers in the field, in addition to guidance for a wide range of medical problems encountered by health professionals in the neonatal care facilities. The guidelines also assist in establishing criteria for admission, discharge, as well as referral and transport to higher, more intensive levels of care throughout the healthcare continuum in the country.

 

The first 28 days of life (the neonatal period) is the most vulnerable time for a child’s survival. Globally about 2.6 million children die in the first month of life, with approximately 7,000 newborns dying every day, most of which occur within the first week of life. Neonatal mortality contributes significantly to under-five deaths (WHO, 2016). Each of these deaths is a tragedy particularly because many of these deaths are preventable.

 

The Kingdom of Eswatini experiences high neonatal mortality rates, with a rate of 20 per 1,000 live births (MICS 2014). As a country, we commit to working tirelessly to reduce the neonatal mortality rates by putting in place all necessary health interventions, ensuring that we meet the global SDG target of less than 10 deaths per 1,000 live births by 2030 and putting an end to preventable neonatal deaths.

 

This first edition of our national neonatal care clinical guidelines is an initiative that aims to ensure that all the neonates in the Kingdom of Eswatini are offered standard, best quality of care and the best possible start in life. The guidelines have been formulated from various global sources and tailored to the needs and health practises of the country. They are designed to serve as a guide to all healthcare providers in the country to provide standardized quality neonatal care.

 

I would like to congratulate the team that worked with zeal and commitment to ensure that this initiative was a success. I hope that the guidelines will offer great learning and will be a useful resource to all healthcare workers caring for neonates. In siSwati we have a slogan ‘Bantfwana bangumliba loya embili’ that means that children are the future. We will continue to strive to let our neonates thrive.