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. 2013 Aug 22;8(8):e72721.
doi: 10.1371/journal.pone.0072721. eCollection 2013.

Neonatal intensive care in a Karen refugee camp: a 4 year descriptive study

Claudia Turner  1 , Verena Carrara, Naw Aye Mya Thein, Naw Chit Mo Mo Win, Paul Turner, Germana Bancone, Nicholas J White, Rose McGready, François Nosten
Affiliations

Neonatal intensive care in a Karen refugee camp: a 4 year descriptive study

Claudia Turner et al. PLoS One. .

Abstract

Background: A third of all deaths in children aged <5 years occur in the neonatal period. Neonatal intensive care is often considered too complex and expensive to be implemented in resource poor settings. Consequently the reductions that have been made in infant mortality in the poorest countries have not been made in the neonatal period. This manuscript describes the activities surrounding the introduction of special care baby unit (SCBU) in a refugee setting and the resulting population impact.

Methods: A SCBU was developed in Maela refugee camp on the Thailand-Myanmar border. This unit comprised of a dedicated area, basic equipment, drugs and staff training. Training was built around neonatal guidelines, comprising six clinical steps: recognition, resuscitation, examination, supportive medical care, specialised medical care, and counselling of parents with sick newborns.

Results: From January 2008 until December 2011, 952 infants were admitted to SCBU. The main admission diagnoses were early onset neonatal sepsis, jaundice and prematurity. Early prematurity (<34 weeks) carried the highest risk of mortality (OR 9.5, 95% CI 5.4-16.5, p<0.001). There was a significant decrease in mortality from 19.3% (2008) to 4.8% (2011) among the infants admitted for prematurity (p=0.03). The neonatal mortality in Maela camp as a whole declined by 51% from 21.8 to 10.7 deaths per 1000 live births over the corresponding period (p=0.04). Staff expressed more confidence in their ability to take care of neonates and there was a more positive attitude towards premature infants.

Conclusion: Neonatal mortality can be reduced in a resource poor setting by introduction of a simple low cost unit specialising in care of sick neonates and run by local health workers following adequate training. Training in recognition and provision of simple interventions at a high standard can increase staff confidence and reduce fatalistic attitudes towards premature neonates.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Diagnosis of infants admitted to SCBU.
Infants could have more than one diagnosis on admission.
Figure 2
Figure 2. The main cause of death of infants addmited to SCBU.
Figure 3
Figure 3. Neonatal mortality in Maela Camp.
See this image and copyright information in PMC

Comment in

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