Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences.

INTRODUCTION: The COVID-19 pandemic is disrupting health systems globally. Maternity care disruptions have been surveyed, but not those related to vulnerable small newborns. We aimed to survey reported disruptions to small and sick newborn care worldwide and undertake thematic analysis of healthcare providers' experiences and proposed mitigation strategies. METHODS: Using a widely disseminated online survey in three languages, we reached out to neonatal healthcare providers. We collected data on COVID-19 preparedness, effects on health personnel and on newborn care services, including kangaroo mother care (KMC), as well as disruptors and solutions. RESULTS: We analysed 1120 responses from 62 countries, mainly low and middle-income countries (LMICs). Preparedness for COVID-19 was suboptimal in terms of guidelines and availability of personal protective equipment. One-third reported routine testing of all pregnant women, but 13% had no testing capacity at all. More than 85% of health personnel feared for their own health and 89% had increased stress. Newborn care practices were disrupted both due to reduced care-seeking and a compromised workforce. More than half reported that evidence-based interventions such as KMC were discontinued or discouraged. Separation of the mother-baby dyad was reported for both COVID-positive mothers (50%) and those with unknown status (16%). Follow-up care was disrupted primarily due to families' fear of visiting hospitals (~73%). CONCLUSION: Newborn care providers are stressed and there is lack clarity and guidelines regarding care of small newborns during the pandemic. There is an urgent need to protect life-saving interventions, such as KMC, threatened by the pandemic, and to be ready to recover and build back better.

Qualitative assessment of patient-provider communication and provider reporting on misclassification of stillbirths and early neonatal deaths in Ethiopia.

BACKGROUND: Poor communication between patients and providers can lead to misunderstanding and misclassification of clinical information, including pregnancy outcomes by women. This qualitative study with maternity care providers explores patient-provider communications regarding stillbirths (SB) and early neonatal deaths (END) and potential SB-END misclassification in Ethiopia. METHODS: Qualitative data were collected through 8 in-depth interviews and 3 focus group discussions with maternity care providers at Tikur Anbessa and Gandhi Memorial hospitals in Addis-Ababa. RESULTS: Twenty-six maternity care providers (10 physicians;16 nurses/midwives) were interviewed. Providers noted that high patient loads negatively influence their provision of quality care to patients. Yet, despite patients generally not asking many questions during their delivery hospitalization, maternity care providers reported offering information about pregnancy outcomes at hospital discharge. The level of education was the most cited factor influencing patients' understanding of the information communicated to them, especially with regard to adverse pregnancy outcomes. Respondents reported that women do not have significant misconceptions about either SB or END. Nevertheless, they also revealed that both purposeful and accidental SB-END misclassification occurs. Reports of the direction of such misclassification differed by type of provider - physicians noted that misclassification of SB as END is most common, while nurses and midwives identified the opposite direction for this type of misclassification. CONCLUSIONS: Maternity care providers' reporting practices and the quality of their communication with patients contribute to the SB-END misclassification in Ethiopia. There is need to increase providers' awareness of the importance of capturing and reporting reliable and valid information on pregnancy outcomes.