Neonatology Fellow , PGY-6 Vanderbilt University School of Medicine Nashville, Tennessee, United States
Background: The Sub-Saharan African region has historically borne the brunt of under-5 child and neonatal mortality. Most reported statistics are based on country-level data. However, these reports fail to unmask inequities in the availability, access, and utilization of resources within different regions or levels of health care within the same country. Identifying and addressing these disparities will promote equitable distribution of resources to improve country-wide neonatal and child survival. Objective: To elucidate the disparities in resource allocation in different regions and levels of health care within different African countries. Design/Methods: An English online survey designed by the authors was administered to conference participants. We surveyed nurses and physicians from 14 African countries representing 95 hospitals during a pan-African neonatology conference hosted in Tanzania which had 214 attendees ;118 nurses and 96 doctors . There were 173 respondents. Results: East Africa was the most represented region with most respondents from Tanzania. 60% of them considered their practice setting urban. 76% had a designated NICU. CPAP was available in 89% of these units. 49% and 41% of the respondents reported availability of mechanical ventilation and blended oxygen respectively in their units. Incubators were available in 89% of the represented healthcare settings. Phototherapy was the most widely available medical equipment (98%). Surfactant and caffeine were commonly difficult to obtain with most respondents unable to routinely access one or both medications. Regarding staffing, 52% of respondents had designated nurses assigned to their units with a majority reporting a nurse-to-patient ratio of less than 1:5 with a typical average daily census in most units being 10-20 patients. Of note, 14% of respondents reported a nurse-to-patient ratio of more than 1:20. While many of the respondents had cared for a less than 26-week gestation age neonate, with a birth weight between 500-749g (42% and 49% respectively), only 21% and 31% respectively had successfully discharged a baby in these categories. Moreover, 52% of respondents reported at least 1 neonatal death per week in their workplace.
Conclusion(s): The results of our survey highlight the variability of resources in Sub-Saharan Africa. Access and utilization within different regions and health care settings vary widely across countries within this area. The accurate characterization of availability and distribution neonatal resources is vital for successful adaptation and implementation of international health policies to improve neonatal survival.
