Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment.

BACKGROUND: Preterm birth is a worldwide challenge with the highest burden in low- and middle-income countries. Despite availability of low-cost interventions to decrease mortality of preterm, low birth weight, and sick newborns, these interventions are not well integrated in the health systems of low- and middle-income countries. The aim of this study was to assess, from the perspective of key stakeholders comprising leaders in the public health system, the health system readiness to support health care facilities in the care provided to preterm, low birth weight, and sick newborns in different regions of Ethiopia. METHODS: A qualitative assessment using in-depth interviews with health facility leaders was conducted in health facilities in 3 regions of Ethiopia from December 2017 to February 2018. The interview guide was developed using a modified version of the World Health Organization health system building blocks. RESULTS: Across the public health system, adequate and reliable space, power, and water were problematic. Human resource issues (training, staffing, and retention) were critical to being able to properly care for preterm, low birth weight, and sick newborns. Problems with functional equipment and equipment distribution systems were widespread. Funds were lacking to support preterm, low birth weight, and sick newborn needs in facilities. Data collection practices, data quality, and data utilization were all problematic. There were gaps in the availability of guidelines and protocols, specifically targeting preterm, low birth weight, and sick newborn care. Key facilitators, information disseminators, and influencers identified in the study were the Health Development Army, community and religious leaders, and mothers and families who had had positive experiences or outcomes of care. CONCLUSIONS: The Ethiopian health system has opportunities across all 7 World Health Organization health system building blocks to strengthen readiness to support health facilities to provide quality care and improve outcomes for preterm, low birth weight, and sick newborns.

A Twin Pregnancy of Partial Mole Coexisting with a Normal Fetus: A Case Report.

Background: Twin pregnancy with partial hydatidiform mole and a co-existing normal fetus (PHMCF) is a very rare clinical condition. It presents with various complications like preterm labor, pre-eclampsia, hyperthyroidism and fetal anomalies. Case Presentation: We report the case of a 40-year-old G13P10A2 mother who was referred to our hospital at 28 weeks as a case of twin pregnancy and pre-eclampsia. She had headache, epigastric pain, bilateral leg swelling, and decreased fetal movement for two days. Her physical examination was remarkable for raised blood pressure and uterus larger than gestational age. Ultrasound findings showed honeycomb-like echo suggestive of a molar pregnancy with a co-existing normal fetus. After she was admitted and managed for severe pre-eclampsia, a cesarean section was done to affect the delivery of a male neonate weighing 1400 grams. Histopathology confirmed the diagnosis of a partial mole with no malignant features. In follow-up, the serum ß-HCG level normalized by the 7th week. Conclusion: PHMCF is a rare obstetric condition. Despite these pregnancies having a greater risk of complications, strict follow-up at a tertiary care hospital and timely management of complications can result in good outcomes for both the mother and the fetus.