Developing context-sensitive, comprehensive newborn care protocols: integrating technologies with clinical care pathways for level 2 newborn units in Kenya

Abstract

Background: An estimated 2.3 million neonates die worldwide each year (47% of under-five mortality), with 75% occurring during the first week of life. The burden is highest in sub-Saharan Africa (n/N = 27/1000 neonatal mortality rate) and largely results from preventable conditions, such as prematurity, birth asphyxia, and infections. The Newborn Essential Solutions and Technologies (NEST360) programme supports health systems in resource-constrained settings (RCSs) through appropriate technologies, training, data use, and mentorship to reduce preventable neonatal deaths. The NEST360 programme, in partnership with the Kenya Ministry of Health, both inspired and enabled the development of evidence-based comprehensive newborn care protocols (NBU-Protocols) and a dissemination training. This article documents the development of the protocols and lessons learned to inform scalable solutions for RCSs.

Methods: The NBU-Protocols and their dissemination programme were developed through a review of evidence on the care for small and sick newborns, followed by iterative feedback from stakeholders, including frontline health workers, academics, and researchers. The protocols were piloted and further revised following a national stakeholder workshop.

Results: The NBU-Protocols comprise three chapters: clinical care pathways; standard operating procedures for NBU equipment; and step-by-step instructions for common clinical procedures performed in level 2 NBUs. The protocols were grounded in family-centred care and infection prevention and control principles. They were presented as e-protocols with hyperlinks, bookmarks, and cross-references to facilitate ease of use. The protocols dissemination programme, called Newborn ETAT+, was a three-pronged training approach taught by experts in the following groups: clinical care pathways by paediatricians; equipment parts and functions by biomedical engineers; and equipment use and care by NBU nurses. A third of the training was dedicated to interactive lectures, with the remainder focussed on demonstrations, simulations, clinical procedures on manikins, and hands-on experience with NBU equipment.

Conclusions: The NBU-Protocols and training model highlight the potential of context-specific, multidisciplinary strategies to improve collaboration and standardise care in NBUs in low- and middle-income countries (LMICs).