Problem Statement: The newborn period carries the highest risk of death in a child’s life. This risk increases significantly if a baby is born premature. Complications of prematurity, infection and asphyxia are the leading cause of death in the newborn period.
At the University of Benin Teaching Hospital (UBTH), the proportion of babies who die because of prematurity is very high. For every 10 premature babies born with birth weight between 1kg to 1.5kg, half of them will die in the hospital and never make it home. If they weigh between 750grams and 1kg, only two will make it home alive. This is in sharp contrast to survival rates in the U.S and European countries where survival of premature babies 1-1.5kg is ~100% and those <1kg is about 70%.
Major Causes of Death in Premature Babies Cared for in UBTH:
1. Premature Lungs: Babies born premature have immature lungs. This causes them to have difficulty breathing that eventually leads to death. There are medications, and devices that can support these babies to prevent them from dying due to difficulty breathing. These medications and devices are not readily available in UBTH, and this causes babies to die. There is also limited staff experience on how to use these medications and devices. The provision of medicines and devices to treat and manage respiratory failure will greatly improve survival.
2. Poor Temperature Control: Because the babies are small, they are at risk of getting very cold. Ideally, these babies should be cared for in an incubator that provides similar warmth as the mother’s womb would have. Unfortunately, the incubators that are available in UBTH are either limited or the available ones are broken. The provision of better equipment, in addition to Kangaroo mother care, to keep the babies warm will greatly improve survival.
3. Infection: Infection are acquired at birth from the mother, or from contamination in the hospital. Several factors increase the risk of acquiring infection in UBTH. These include; poor hand washing practices, faulty plumbing, unsanitary fittings and a lack of clean towels (paper or cloth) to dry hands after washing. The provision of resources and training on hand washing will greatly reduce the proportion of babies that die in UBTH.
How we plan to reduce the number of babies that die in the UBTH nursery and improve care.
I have collaborated with the management of UBTH and the doctors working in the UBTH Special Care Baby Nursery (SCBU). ● I will provide guidance to the management on how to renovate SCBU to be more functional. ● I and other doctors and nurses from my institution here in the US (Indiana University) will provide in-person training to the doctors and nurses working in the SCBU on how to provide highly specialized critical care for very sick and premature babies, including conducting quality improvement projects on hand washing, maintenance of equipment, cleaning equipment to name a few. ● With your help, I will raise funds to equip 10 high acuity beds with needed equipment and medications to overcome the major causes of death.
What We Have Done So Far:
1. Hand washing Practices: We have purchased 2500 hand towels, a washer and dryer. We are finalizing the details on the quality improvement project that we detail what change in practice we want, how we are going to implement the change, how we will measure the impact of the change, and how we will sustain the change.
2. Training: We will hold our first in-person training, summer of 2020. The trainers will include, two neonatologists, a neonatal nurse and a neonatal fellow. We will develop guidelines, protocols, and policies for nurses, doctors and allied medical staff.
3. Guidance on the unit re-design: I worked with an architect to redesign the unit to have better function for the patients, parents, and medical staff.
Things to note in the OLD plan:
Areas marked with Orange star are underutilized spaces and areas marked with Green star have very poor function for patients, parents and medical staff.
Areas marked with Purple start are new additions and areas marked with Red star indicates high dependency.
The management of UBTH has started work on the remodel
4) Raising funds to support this project:
We have selected equipment that are cost-effective and practical for this setting. We have grouped the equipment’s into critical and essential. Critical means the equipment’s will make the most impact, are cost-effective, easy to maintain, and are of low technological profile. The equipment’s will ensure that a child who needs moderate to mild support does not die. The second group of equipment are essential. This means that they have the potential to improve survival for the very sickest of patients when combined with the critical equipment. They are, however, more expensive, and require higher technological support. We have made efforts to select devices that do not need so much maintenance; they double as in-hospital and fieldwork machines, so they are durable, rugged, and sensible not to overburden the system or the patients.
The Critical Equipment to Support 10 Critical Care Beds
A) Diamedica CPAP Device (Donate)
Specification:
● It is an oxygen concentrator so there is no need for additional oxygen tanks.
● It has an inbuilt oxygen blender so the babies are not receiving 100% oxygen which have deleterious effects on the premature baby.
● It is portable.
Number required: 10
Unit cost: $3000. (N1,000,000)
B) A bundle of consumable and medications (Donate)
Specification:
● The bundle will include an oxygen saturation and heart rate monitor, stethoscope, surfactant medication, endotracheal tube, CPAP nasal prongs, and thermometer.
Application:
● The funds we generate here will serve as a consumable/medication revolving fund. A portion of the patients hospital bill will earmarked to replace items in the bundle. The capital we raise is to ensure these consumables are always present for use.
Number required: 10 bundles
Unit cost: $400 (N150,000)
C) A Mechanical Ventilator: Hamilton C1 (Donate)
Specification:
● It is turbine driven and entrains air so it does not need medical air (added expense) to run it. It is portable, very sturdy and practical.
Number required: 2
Unit cost: $15,000 (N5,500,000). The Hamilton company agreed to a discounted price for this ventilator, which typically cost upwards of $20,000.
D) Incubator: Phoenix INC-100 Incubator (Donate)
Specification:
● Low cost, easy to maintain, company is local in Nigeria, will install and service periodically.
Number required: 10
Unit cost: $5000 (N1, 800,000) Quote by JNCI company in Nigeria.
E) Blood gas analyzer: Siemens (Donate)
Specification:
● Has to capacity to run multiple test.
● Essential tool when caring for a patient on a ventilator or CPAP machine.
Number required: 1
Unit cost: $25,000
F) Digital Mobile Chest X-ray Machine: GE (Donate)
Specification:
● Essential component to caring a patient on a ventilator or CPAP machine.
● Babies who need a chest x-ray are too fragile to leave the medical unit to the radiology department.
Number required: 1
Unit cost: $50,000
How you can support this initiative:
1) Diamedica CPAP Device:
You can provide us with the funds to purchase one or more devices: (Click here to make a Donation)
You may want to purchase the device from the manufacturer directly
Account Name: Diamedica (UK) Ltd.
Lloyds Bank plc, 17 Cross Street, Barnstaple, Devon
EX31 1BE
Account No: 02611802
Sort Code: 30-90-49
IBAN: GB11 LOYD 3090 4902 6118 02
SWIFT / BIC: LOYDGB21290
2) A bundle of consumable and medications
a. You can provide us with the funds to purchase one or more bundle: (Click here to make a Donation)
b. You can provide us with the part of the funds to purchase one bundle. Once we raise the cost of one bundle we will purchase it.
3) Hamilton Mechanical Ventilator
a. You can provide us with the funds to purchase one or more bundle: (Click here to make a Donation)
b. We can provide you with the contact information of the Hamilton sales representative.
4) Incubator: Phoenix INC-100 Incubator
a. You can provide us with the funds to purchase one or more devices: (Click here to make a Donation)
b. We can provide you with the contact information of JNC International Limited, 30 Raymond Njoku Street, Off Awolowo Road, South-West, Ikoyi, Lagos, Nigeria. Tel: 4630227, 0803 3012351
5) Siemens Blood gas analyzer
a. You can provide us with the funds to purchase one or more devices: (Click here to make a Donation)
b. We can provide you with the contact information of the Siemens sales representative.
6) GE digital mobile X-ray
a. You can provide us with the funds to purchase one or more devices: (Click here to make a Donation)
b. We can provide you with the contact information of the GE sales representative.
How we will reassure you that your support is being utilized effectively and that it is making a meaningful difference.
You will be provided with semi-annual newsletters that will include a summary of what support we have raised, what the funds went towards (equipment, medications, training etc.), the number of babies that have benefited from your support, and most importantly the change in survival rates overtime.