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Cycle 1

Newborn Infection Control and Care Initiative for Health Facilities to Accelerate Reduction of Neonatal Mortality (NICCI)

Principal Investigator: Chivorn Var, National Institute of Public Health (NIPH), Cambodia
NIH-Supported Collaborator: Robert Oberhelman, Tulane School of Public Health and Tropical Medicine
Title of NIH Award: Inter American Training for Innovations in Emerging Infectious Diseases
Project Dates: October 2018 - March 2018

Project Overview
Newborn mortality continues to be unacceptably high in Cambodia, despite reductions in maternal and under five year old mortality. Evidence exists that a large proportion of newborn mortality globally and in Cambodia is attributable to infections and sepsis and must be addressed. A surge in the number of births at Health Centers unprepared for increased caseloads has likely contributed to substandard hygiene practices and referral. The goal of the project is to implement and evaluate a linked intervention to reduce newborn mortality and morbidity by addressing infection control in the perinatal period, improving recognition of newborn illness, and facilitating prompt referral to appropriate care. The project has two objectives: 1) to improve infection control behavior by staff in selected Health Centers and train health workers in infection control messages to be delivered to pregnant and newly delivered women; 2) to improve referral of sick newborns by Village Health Support Group (VHSG) volunteers and HC staff through: a) increased recognition of danger signs, b) shorter time between recognition of danger signs and care seeking at an appropriate health facility; and 3) to describe the causes of sepsis among infants with possible sepsis from a subset of health center catchment areas. The study will use an experimental design to evaluate a package intervention for the reduction of newborn mortality. The study will incorporate mixed methods including: formative (qualitative) research, a stepped wedge cluster randomized intervention trial and process evaluation. It is anticipated that the results of this study will provide data for policy level actions on newborn survival in Cambodia and in other settings with similar health outcomes. The study may contribute to the potential scale up of a linked model of community-facility care for newborns.

Summary of Recent Activities: 

1-15 Var with baby
Principal Investigator and Project Coordinator observed project staff interviewing new delivery mothers in Tropaing Snor & Prey Changreak villages.

During the final quarter of 2017, Dr. Var and his colleagues were busy with analysis of their results, including final data cleaning and verification. They tested a preliminary model for multivariate regression, but it was deemed incomplete. After identifying certain errors, they improved and finalized the data set and completed bivariate analysis, which indicated useful impacts on primary and secondary outcomes for the intervention. A new model for the multivariate analysis is in progress, and preliminary outcomes from this model will be available in early 2018.

Meanwhile, project team members made a presentation on “Gaps in Recommended Practices in Newborn Care at Health Facility and Home” at the 16th Symposium of the Society of Cambodian Gynecologists and Obstetricians (SCGO) in Phnom Penh, November 17-18, 2017. There were a total of 265 participants, including gynecologists working in private and government hospitals, national program managers, and representatives of the Ministry of Health. The presentation and lessons learned shared by the PEER team may help the participants to improve their training and practice in neonatal care. In addition, the PI Dr. Var reports that in 2017 he was appointed by the Secretary of State of the Ministry of Health as a member of the Technical Working Group (TWG) on Training Curriculums in Strengthening
Management and Leadership of Health Sector Managers in Cambodia. During one of the TWG meetings, the PI and other group members included Infection Control/WASH as one of the training competencies in the Health Care Facilities category. Infection control and hygiene are among the interventions tested in this PEER project, so through Dr. Var’s participation in the TWG he expects to apply lessons learned from the intervention to improve training curricula for health care managers in the country. Currently he and his team are continuing to develop the curriculum among other training materials, and they expect to train the first group of managers by the end of 2018.

The PEER project will be ending as of March 31, 2018, so in these final months the team is continuing to analyze their data and prepare their final report. A dissemination workshop on the project is being held on February 21, 2018, and project results will also be shared through separate meetings with the Takeo Provincial Health Department and with Master’s students at the National Institute of Public Health.

Health Cycle 1 Recipients