The delivery of essential newborn care in conflict settings: A systematic review

Vinay Kampalath; Sarah MacLean; Abrar AlAbdulhadi; Morgan Congdon

doi:10.3389/fped.2022.937751

The delivery of essential newborn care in conflict settings: A systematic review

Front Pediatr. 2022 Nov 1:10:937751. doi: 10.3389/fped.2022.937751. eCollection 2022.

Authors

Vinay Kampalath^{1

2

3

4}, Sarah MacLean⁵, Abrar AlAbdulhadi⁵, Morgan Congdon^{2

4

6}

Affiliations

¹ Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
² Center for Global Health, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
³ London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.
⁴ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
⁵ Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
⁶ Section of Hospital Medicine, Division of General Pediatrics, Department of Pediatrics, Global Children's Hospital of Philadelphia, Philadelphia, PA, United States.

Abstract

Introduction: Although progress has been made over the past 30 years to decrease neonatal mortality rates, reductions have been uneven. Globally, the highest neonatal mortality rates are concentrated in countries chronically affected by conflict. Essential newborn care (ENC), which comprises critical therapeutic interventions for every newborn, such as thermal care, initiation of breathing, feeding support, and infection prevention, is an important strategy to decrease neonatal mortality in humanitarian settings. We sought to understand the barriers to and facilitators of ENC delivery in conflict settings.

Methods: We systematically searched Ovid/MEDLINE, Embase, CINAHL, and Cochrane databases using terms related to conflict, newborns, and health care delivery. We also reviewed grey literature from the Healthy Newborn Network and several international non-governmental organization databases. We included original research on conflict-affected populations that primarily focused on ENC delivery. Study characteristics were extracted and descriptively analyzed, and quality assessments were performed.

Results: A total of 1,533 abstracts were screened, and ten publications met the criteria for final full-text review. Several barriers emerged from the reviewed studies and were subdivided by barrier level: patient, staff, facility, and humanitarian setting. Patients faced obstacles related to transportation, cost, and access, and mothers had poor knowledge of newborn danger signs. There were difficulties related to training and retaining staff. Facilities lacked supplies, protocols, and data collection strategies.

Conclusions: Strategies for improved ENC implementation include maternal and provider education and increasing facility readiness through upgrades in infrastructure, guidelines, and health information systems. Community-based approaches may also play a vital role in strengthening ENC.

Keywords: conflict; global health; humanitarian; neonatal; pediatrics; perinatal mortality; refugee.

Publication types

Review