Improving immediate newborn care practices in

Philippine hospitals: impact of a national quality

of care initiative (2018)
JOURNAL

Submitted by:
Tamayo, Teanu Jose G. BSN-III D4

In partial Fulfillment of requirement

In CN 109: Duty

Submitted to:
Ceralde, Jacqueline S. RN, MN

June 14, 2018

Supporting articles:

Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services
in the Philippines: Pre- to Posttraining Assessments (2016)

Essential Newborn Care during Humanitarian Crises: Integration of Low-Cost Interventions (2017)
B. SUMMARY

i. Introduction

In summary from what I’ve read: in the Philippines, in the year 2009, began a hospital-based initiative
to change childbirth practices to newborn care. This initiative called Scale up EINC Project, with support
from WHO and the Joint Programme on Maternal and Neonatal Health (JPMNH), was piloted. Known
better as the Unang Yakap 4&5 (in relation to MDG 4&5).

Prior to the implementation, neonatal deaths accounted for 44% of under-5 deaths with a mortality rate
of 15 deaths per 1000 live births (Knoema,2016). And following a deadly outbreak of early neonatal sepsis
in an urban hospital in 2008, an assessment of intrapartum and immediate newborn care in 51 large hospitals
revealed inappropriate practices in the 481 deliveries observed.
Summarized as:
 <10% of newborns received skin-to-skin
 Unnecessary suctioning despite knowledge of risks
 Substances applied to cord stump 99% of the time despite global recommendation of dry cord
clamping. (WHO, 2017)
 Early bathing, delayed breastfeeding initiation, immediate cord clamping.

As a response, the Philippines Department of Health (DOH), World Health Organization (WHO) and
partners developed and adopted a systems approach to improve newborn care practices described earlier.

ii. Gap of the Study and Research Objective

Hence, this national intervention and findings of hospital care assessments was conducted in 2008 and
2015 to investigate whether practices had improved. Quantifying the effectiveness and sustainability of the
Philippine approach is crucial for understanding the potential impact of future national programming.

With the primary objective of this study was to determine whether intrapartum and newborn care
practices improved in 11 large hospitals between 2008 and 2015.

iii. Methods

From the years 2008 and 2015, the study gathered data from eleven large government hospitals from
five regions in the Philippines utilizing secondary data analysis of observational assessments of the one
hundred and seven randomly sampled postpartum mother–baby pairs in 2008 and 106 randomly sampled
postpartum mothers prior to discharge from hospitals after delivery.

Between 2009 and 2011, DOH and WHO worked with professional organizations and other
stakeholders to review and update newborn clinical practice guidelines using the Grading of

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Recommendations, Assessment, Development and
Evaluation (GRADE) approach to assess quality of
evidence. The figure at the right describes the process of
quality improvement in intrapartum and newborn care in
the Philippines.

iv. Results

Analyzed from the results and discussions in the

study, initiation of drying within 5s of birth, delayed cord
clamping, dry cord care, uninterrupted skin-to-skin
contact, timing and duration of the initial breastfeed, and
bathing deferred until 6 h after birth all vastly improved
(P<0.001). The proportion of newborns receiving
hygienic cord handling and the hepatitis B birth dose
decreased by 11–12%. Except for reduced induction of
labor, inappropriate maternal care practices persisted as
evidenced by statistical insignificant declines of
episiotomies.

C. REACTION:
1. Insights/Relevance to patients’ care/care

Summarizing points from the journal relevant

to patient’s care:

• from the adoption of the approach of EINC, this

reflects a shift from the traditional didactic training
(previously condescending, and patronizing in approach to the learner whether student nurse, midwife or
doctor in training) to a training focusing on practice, assessment and environment manipulation.
• Priority was duly given in the importance of providing quality care for women during labor and delivery
and implementation of safe practices for their newborns to ensure their best outcomes became paramount
founded by evidenced-based interventions.
• As a student nurse doors have been open to an environment more exposed for opportunities to practice
quality improvements in the patient’s care considering the periodic assessments and weekly meetings to
improve newborn care practices in affiliated hospitals and hospitals nationwide.

2. Relevance to area of rotation/local setting/Phil.

Described earlier, practice of unnecessary or unindicated interventions were being performed. This
being: unnecessary suctioning, application of substances to the cord stump, early bathing etc. Considering
socio-financial development of those less privileged, a program (EINC) aimed to practice EBP’s utilizing
only the needed materials and resources is ideal here in the Philippines.

In the study “Turning Disaster into an Opportunity for Quality Improvement in Essential
Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments” by Castillo
et al. (2016), gaps in quality of care were brought to light in the wake of calamity, wherein the Essential
Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1

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and 3 months afer training) were undertaken resulting to a conclusion of the effectivity of the EINC, even
in a post-disaster setting. (abstract found at appendix)

3. Relevance to Nursing Education, Practice and Research

That being said, nursing education and practice aim to find the most effective and efficient way to
deliver holistic care through evidenced based research and practice. Updates such these are massive leaps
towards nursing research, doing away with outdated practices with possible complications associated with
them, such as the risk of hypoxia and haemodynamic instability due to unnecessary suctioning.

In relation to nursing education, the EINC, in my perspective, is a comprehensive step-by-step set

of guidelines and algorithms easily integrated into any curriculum with its direct-to-the-point presentation.
This ensured that in practice, together with the knowledge discussed about maternal and child nursing,
quality and standard are maintained. Mentioned aswell before, the EINC opens opportunities for future
researches in quality improvements as technology and experience progress with use of the program.

4. Learning Insights on the Journal

Reiterating some points stated, the EINC/Unang Yakap 4&5 was essential in such a time where
neonatal deaths accounted for a 44% of deaths under the age of five. From a total of 15 deaths per 1000
live births in 2008 to a 12.6 deaths per 1000 live births in 2016, it may not seem such a big step, but if it’s
2 less deaths, it is a step in the positive direction. This perpetuates further study and research to be done in
the improvement of quality.

Quality improvement that entails the collaboration of the different sectors of health care and the
guidance of professional and accredited organizations spearheading advancements in reducing child
mortality and improving maternal health here in the Philippines.

References:

Castillo, M. S., Corsino, M. A., Calibo, A. P., Zeck, W., Capili, D. S., Andrade, L. C., . . . Silvestre, M. A. (2016).
Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care
Services in the Philippines: Pre- to Posttraining Assessments. BioMed Research International, 2016, 1-9.
doi:10.1155/2016/6264249

Philippines Neonatal mortality rate, 1960-2017. (2016). Retrieved June 14, 2018, from
https://knoema.com/atlas/Philippines/Neonatal-mortality-rate

Philippines Under-5 mortality rate, 1950-2017. (2015). Retrieved June 14, 2018, from
https://knoema.com/atlas/Philippines/topics/Demographics/Mortality/Under-5-mortality-rate

Silvestre, M. A., Mannava, P., Corsino, M. A., Capili, D. S., Calibo, A. P., Tan, C. F., . . . Sobel, H. L. (2018).
Improving immediate newborn care practices in Philippine hospitals: Impact of a national quality of care
initiative 2008–2015. International Journal for Quality in Health Care. doi:10.1093/intqhc/mzy049

Wong, A. (2017) Essential Newborn Care during Humanitarian Crises: Integration of Low-Cost Interventions.
Independent Study Project, 2017, 2-29

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World Health Organization. (2017) WHO Recommendations on Newborn Health: Guidelines Approved by the
WHO Guidelines Review Committee. Geneva: World Health Organization.

Turning Disaster into an Opportunity for Quality Improvement

in Essential Intrapartum and Newborn Care
Services in the Philippines: Pre- to Posttraining Assessments

Essential Newborn Care during Humanitarian Crises:

Integration of Low-Cost Interventions

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