A retrospective review of trends in neonatal mortality in a regional hospital in the Eastern Cape: Quality improvement in action
Background: Dora Nginza Hospital had a high neonatal mortality rate (NMR) of 32.5/1000 live births in 2016. Quality improvement strategies were introduced between 2016 and 2020 in order to improve neonatal outcomes. Aim and objectives: The aim of the study was to report changes in neonatal mortality at Dora Nginza Hospital in the Eastern Cape, using available data from 2016 as baseline. Methods: A retrospective review of monthly neonatal statistics and morbidity and mortality audits was conducted. Primary outcome was neonatal death rates (NDR) by month and year from 1 January 2016 to 31 December 2019. Secondary outcomes included early (ENDR) and late neonatal death rates (LNDR) by year, annual neonatal death rates by birth weight categories ≥500g and ≥1000g, and major causes of neonatal deaths. Chi square test and relative risk were used to compare differences in outcomes and p<0.05 was considered significant. Ethics approval was granted prior to commencement. Results: NDR declined at a rate of 4.5 deaths per 1000 live births annually from 32.5 / 1000 live births to 19.0 / 1000 (p < 0.005). Reduction in ENDR was statistically significant (p < 0.005) but not LNDR (p (LNDR≥500g) = 0.167 and p (LNDR≥1000g) = 0.87). Relative risk of early and/or late neonatal death was 0.59 (0.48 – 0.72) in the ≥500g birth weight category (p <0.005) and 0.69 (0.53 – 0.91) in the ≥1000g birth weight category (p = 0.008). Deaths due to prematurity decreased by 63.9% from 108 to 39 (p<0.005). There was a 12.5% increase in deaths due to congenital abnormalities from 24 to 27 but this did not reach statistical significance (p = 0.051). There was no significant difference in the number of deaths due to infection, intrapartum events or other/uncategorised causes. Conclusion: There has been significant improvement in neonatal survival at Dora Nginza Hospital from 2016 to 2019, mainly due to decreased early neonatal deaths related to prematurity. Strategies to improve infection prevention and control, reduce adverse intrapartum events and streamline organisation and integration of district and regional neonatal services will be fundamental to ongoing quality improvement.