RESUMEN
BACKGROUND: Neonatal hypothermia significantly contributes to infant morbidity and mortality in low-resource settings like Malawi. Kangaroo mother care (KMC) is essential but faces challenges in providing continuous thermal support. The Dream Warmer is a neonatal warming device that was developed to complement KMC. We studied its implementation outside a research environment. METHODS: Using an implementation science approach, we conducted a prospective interventional cohort study in two hospitals and four health centres in Malawi. Through audits and surveys, we assessed the effect of the Dream Warmer on neonatal hypothermia as well as healthcare provider (HCP) and parent attitudes regarding thermoregulation and related issues. RESULTS: The Dream Warmer raised no safety concerns and effectively treated hypothermia in 90% of uses. It was positively received by HCPs and parents, who reported it had a favourable effect on the care of small and sick newborns. Challenges identified included a scarcity of water and electricity, lack of availability of the device and HCPs forgetting to prepare it in advance of need or to use it when indicated. Feedback for future training was obtained. The Dream Warmer's strong safety and effectiveness performance is consistent with results from strict research studies. Training materials can be adapted to optimize integration into daily practice and provide educational content for parents. CONCLUSIONS: The Dream Warmer is a safe and effective device to treat neonatal hypothermia, particularly when KMC is insufficient. We gained an understanding of how to optimize implementation through robust HCP and family education to help combat hypothermia.
RESUMEN
BACKGROUND: The WHO introduced the Surgical Safety Checklist (SSC) in 2008, which has been proven to enhance collaboration and patient safety before, during and after surgical procedures. However, the impact of using SSC has not been assessed in a rural setting in Malawi. We aimed to evaluate the uptake of SSC in Neno District, Malawi. METHODS: We conducted a cross-sectional hospital-based retrospective chart review of 468 surgical cases from July 2021 to March 2022 in two hospitals in Neno District. We collected data using Excel and used R software for analysis. We used descriptive statistics to characterise the surgeries. We used χ2 test and Wilcoxon signed-rank test to test the association between SSC use and independent variables. We fitted logistic regression to assess predictors of SSC use and complications. RESULTS: Of 468 surgical cases, 92% (n=431) were done as emergency procedures. The median age was 23 years (IQR: 19-29) and 94% (n=439) were female. Overall, 38% of surgeries (n=176) used the SSC and of these, 98% were in emergency procedures. We found an association between the use of SSC and the age of the client (p=0.018), type of procedure, name of the procedure, healthcare worker cadre, time procedure performed and complications (p<0.001). However, no association was observed between SSC use and outcome (p>0.05). The odds of using SSC were higher in emergency surgeries, surgeries performed at night; however, they were lower among temporary employees and anaesthetists with a diploma (p<0.001). The odds of experiencing complications were 1.71 times greater when using SSC compared with surgeries without SSC (p=0.029). CONCLUSIONS: The use of an SSC in a rural area was promising, despite its fluctuating use and this needs programme improvement. Further studies are highly recommended to understand the fluctuation in the use of the SSC.
