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Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study

PLoS Medicine Jul 29, 2019

Hanson C, et al. - Via a cross-sectional study between May 30, and August 26, 2016, as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) providing neonatal intensive care, researchers intended to evaluate care practices, causes of admission, and outcomes from neonatal intensive care units in public secondary and private tertiary hospitals and both public and private medical colleges recruited in a quality improvement collaborative in Telangana and Andhra Pradesh—2 Indian states with a population of 35 and 50 million, respectively. Equipment, supplies, and staffing were according to government rules except for the rooms that permitted mothers to breastfeed or to lie down for Kangaroo Mother Care were not there in all hospitals. Moreover, as suggested in government rules, government hospitals had only 1 instead of 4 pediatricians per 10 beds. Relative to auscultation and temperature measurement, admission care processes were substandard, especially in public facilities. On evaluating 6,859 register records, in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, 4%, 15%, 4%, and 2% of neonates admitted, respectively, expired by the age of 28 days. However, the assessment was complex by a huge number of missing records, which was more prevalent in private than public facilities. Hence, variations in the quality of neonatal intensive care and 28-day survival among the various types of hospitals were inferred, however, comparison of outcomes was complicated by variations in the case-mix and referral practices among hospitals. furthermore, to evaluate the advantages for the population of mixed-care provision, uniform reporting of outcomes and risk factors across the private and public sectors is needed.
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