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Table 1 Quality Improvement interventions classified according to the Donabedian framework

From: Reduced neonatal mortality in a regional hospital in Mozambique linked to a Quality Improvement intervention

Structures Process Outcomes
Structural Lack of space dedicated to the KMC Creation of two new rooms with six extra beds for KMC, for a total of fifteen beds Reduction of neonatal mortality due to asphyxia, prematurity and sepsis
No bathroom for the mothers Rehabilitation of one bathroom for the patients and one for the NICU staff
No mosquito nets on beds Painting walls, repairing windows and installation of impregnated mosquito nets for each KMC bed
Equipment Lack of equipment and supplies Oxygen concentrators with implementation of pulse oximeter utilization and technical maintenance
Glucometer and point-of-care testing for C-Reactive Protein and technical maintenance
UVB light for phototherapy and technical maintenance
Infusion pumps and technical maintenance
First and second line antibiotics
Clinical Lack of standardization of the quality of work between different doctors Creation of diagnostic-therapeutic protocols for the main neonatal diseases (sepsis, dyspnea, prematurity, asphyxia, hypoglycemia, neonatal seizures, enteral feeding)
Lack of internal organization Monthly meeting with doctors working in the NICU focused on good clinical practice, discussion of case reports, medical issues and protocols
Scheduled visiting hours, ward access permitted only to internal personnel and families
Organized staff shifts
Payment of an extra shift performed by a nurse during the afternoon and night to obtain a nurse/patient ratio of 1/15 compared to 1/30 of the pre-intervention
Lack of basic hygienic rules Meeting twice a month with nurses and NICU’s staff on hand washing, cup feeding, newborn cleaning, water purification for hand washing and formula milk preparation
Lack of theoretical knowledge and technical skills about the neonatal resuscitation in the delivery room Organization of a neonatal resuscitation course for the midwives on January 2014 with a Portuguese-speaking certified neonatologist midwives
On-the-job training by a certified local midwife a week per month
Weekly meeting with the midwives with discussion of one clinical case
Installation of a camera in the delivery room and in the operating room to record 24/7 the neonatal resuscitation made by the midwives working in the Obstetrical Department to evaluate their performances