Neonatal Nursing Education
Despite substantial progress in reducing child mortality over the past several decades, the proportion of neonatal deaths among under-five deaths increased from 40% in 1990 to 47% in 2019. Increased focus on neonatal survival is paramount if the world is to make significant gains on the Sustainable Development Goal (SDG) target on child survival. The vast majority of neonatal deaths occur in babies born prematurely, babies with infections, or babies asphyxiated around the time of delivery. Prematurity is the leading cause of newborn deaths in the first month of life globally, and 15 million babies are born prematurely every year. Global disparities in neonatal mortality are stark—with a ten times higher chance of a baby dying during the first month of life in sub-Saharan Africa compared to high-income countries. Optimal supportive care in a hospital Special Care Baby Unit (SCBU) could avert 70% of neonatal deaths due to preterm birth and lack of timely decision-making to prevent infections and manage emergencies. There is, however, a critical human resource gap for a neonatal nursing cadre to serve in SCBUs, with limited neonatal nursing programs outside of high-income countries.
The Neonatal Nursing Education Initiative
The human resource gap for skilled nurses to care for sick newborns is critical, particularly in those countries which account for the highest newborn morbidity and mortality rates. Nurse Midwives and Pediatric Nurses are trained to care for mothers during the perinatal period and childhood respectively; however, there is a gap in specialty health care for premature, small, and sick newborns. In-service training can be beneficial, but it fails to build sustainable local capacity to improve neonatal survival over the long term. The scope of practice for current nurses and midwives does not include extended care of the sick or premature newborn, however, appropriate care during, immediately after birth and beyond is critical. High quality care for sick neonates includes rapid detection and careful monitoring by trained health professionals with a sound understanding of the physiological and psychosocial needs involving timely and high-quality comprehensive care, careful temperature management, adequate breastfeeding support, safe oxygen therapy, effective phototherapy, prevention and treatment of infections and management of other complications, and provision of family support. Care for sick and premature newborns requires dedicated clinical space, staffed by dedicated nurses with specialist training and skills.
Evidence of Life-saving Impact
The continued high neonatal mortality rate and gap in quality of care for the small, preterm, and sick newborn needs to be addressed by strengthening health systems and supporting countries’ ability to be more self-reliant in planning, financing, and implementing solutions to their own development. Studies support that advanced preparation of neonatal nurses improves the quality of care and helps vulnerable babies survive. For over 30 years countries such as the United States, United Kingdom, Australia, Canada, and New Zealand have built specialty training for neonatal nurses at academic institutions resulting in a recognized qualification. The result in many countries has been recruitment and retention of nurses in the specialty as well as improved neonatal outcomes. It is well-accepted that neonatal care should be provided by skilled health care workers and professionals as a first line defense in health care as this is more cost effective than emergency, critical, or long-term care.
Advancing Neonatal Nursing Education to Lower Neonatal Mortality in Sierra Leone & Malawi
The establishment of a new cadre of neonatal specialists will provide a sustainable approach to improving standards of care and an institutional approach to educating neonatal nurses. Project HOPE maintains initiatives and partnerships that focus on maternal and child health, such as antenatal care and safe delivery support, but is giving increased attention to further advancing care of vulnerable newborns.
For these reasons, Project HOPE closely collaborated with the College of Medicine and Health Science at the University of Sierra Leone (COMAHS) and University of Malawi, Kamuzu University of Health Sciences (KUHeS), formerly Kamuzu College of Nursing, to develop and implement Neonatal Nursing programs at the Bachelor of Science (BSc) level. Various country-level stakeholders and global-level collaborators, including Thomas Jefferson University College of Nursing and the Council of International Neonatal Nursing (COINN Inc.), were partners in the effort to develop a curriculum that met global standards and work with faculty to teach quality care of small, premature, and sick neonates.
History in Sierra Leone & Malawi
Sierra Leone has a high neonatal mortality rate (NMR) at 31/1,000 live births which accounted for 32% of all under-five mortality in 2017 with 30% of the neonatal deaths resulting from pre-term/low birth weight births. They have recently developed a National RMNCH Strategy 2017-2021, and Every Newborn Action Plan (ENAP) as pathways to improve newborn care and are ready to develop advanced neonatal nursing care with partners and stakeholders. Project HOPE has focused on intensive national and district trainings on Essential Newborn Care, Care of the Small Baby, and Helping Babies to Breathe and emergency management; establishment of two Kangaroo Mother Care Units (KMC) which were the first in the country; initiation of community care groups on newborn care in the home and community; development of a clinical Neonatal Nursing training/learning Center in Bo District Hospital that provides resources and clinical training to nurses who care for small and sick newborns; and mentorship in the SCBUs.
Malawi also has a high neonatal mortality rate (NMR) at 20/1,000 live births which accounted for 44% of all under-five mortality. Malawi is committed to advance neonatal care and avert deaths. The country has a five-year plan to improve newborn care, has established a national Newborn Technical Advisory Committee, and is ready to develop advanced neonatal nursing education with partners and stakeholders. Project HOPE’s long-term presence in Malawi in RMNCH, HIV and PMTCT programming and interest in focusing on newborn quality of care prompted national stakeholders to request discussions on establishing a new cadre of neonatal nurses.