Proceedings of the first ANA Biannual General meeting and Scientific Conference of the African Neonatal Association 2025

Résumé

Introduction: Evidence-based interventions in the first hour of life, the “Golden Hour”, lead to improved outcomes, particularly in low birth weight (LBW) and premature infants. Despite  evidence of cost-effectiveness, the implementation of interventions including early skin -to-skin care (ESSC) and delayed cord clamping (DCC), remains inconsistent globally. We introduced a  quality improvement (QI) programme to improve Golden Hour practices in a central maternity hospital in Zimbabwe (~21,000 deliveries annually). 
Methodology: We utilised QI methodology with iterative Plan-Do-Study-Act cycles, over 6 months from November 2024, including a two-monthly interactive teaching program, equipment provision,  healthcare provider incentives (food hamper), regular clinical support and feedback meetings. Data were collected for all deliveries, temperature recorded for neonatal unit admissions and  then descriptively analysed. 
Results: An observational audit estimated preimplementation rates of DCC and ESSC at 50%, but without documentation. With this project we recorded improved documentation and adherence to  both interventions; 43% at baseline to 76-87% by month 6. Following identification of poorly adherent groups, targeted training resulted in improved rates of DCC for babies born in theatres (6.5 to 19%) and LBW babies (27 to 64%). 7012 of 9812 (71.5%) eligible babies received both interventions. Babies’ temperature varied with seasonal trends but not with Golden Hour  interventions. 
Conclusions: Golden Hour interventions were implemented in a low-resource, busy maternity unit. There are ongoing challenges improving the duration of ESSC, thermoregulation and  implementation in vulnerable groups. Next steps include use of observational data to assess impact on survival.