Niger J Paed 2016; 43 (1):8 – 13

ORIGINAL

Okonkwo IR

Scope of neonatal care services in

Abhulimhen-Iyoha BI

major Nigerian hospitals

Okolo AA

DOI:http://dx.doi.org/10.4314/njp.v43i1.2

Accepted: 12th October 2015

Abstract : Background: Neonatal

cilities, 34 (63%) were located in

survival bespeaks the quality of

state capitals and 47 (87%) in pub-

Okolo AA

(

)

neonatal care services available

lic hospitals. Half of the evaluated

Okonkwo IR

and accessible to the population.

units belonged to Class I, 22

Abhulimhen-Iyoha BI

Department of Child Health,

Intensive care improves outcome

(40.7%) Class II, and 5 (9.3%)

University of Benin Teaching Hospital,

of high-risk infants with serious

Class III levels of neonatal care.

PMB1111

illness. The tiered level of care is

Majority (81.6%) of the doctors

Benin City, Nigeria

yet to be applied to newborn care

have been trained on neonatal re-

Email: angelneneo@yahoo.com

in Nigeria. Classification of care

suscitation; with senior residents

is key to improving neonatal sur-

being the highest 49 (89%) and

vival with enhanced referral of

Medical officers (MO) the least 4

high-risk patients to higher-level

(40%) trained. Doctors with train-

centres.

ing in mechanical ventilation

Objective: To ascertain the scope

(MV) were 39.2%; Consultants

and classify available newborn

(51.2%), MO’s the least 1(11.2%)

services offered at major Nigerian

trained (p=0.025). Monitoring is

hospitals.

usually by pulse oximeters 54

Methodology: A semi-structured

(100%), multi parameter monitors

validated questionnaire was ad-

23 (42.6%) and rarely ABGs 6

ministered to attendees during

(11%).

2015 Pediatric Association of

Conclusion: Neonatal care in Ni-

Nigeria conference. The informa-

geria is still developing. Most cen-

tion derived was used to catego-

tres provide basic neonatal care

rize neonatal care services.

services. Regionalization of care

Results: The respondents con-

may be the solution to higher level

sisted of doctors 201 (84.8%) and

neonatal care.

nurses 36 (15.2%) in 54 health

facilities from all geopolitical

Key Words:

Neonatal Care;

regions of Nigeria. Of the 54 fa-

Scope

Introduction

such key specialists. Whatever the situation, team

members must be able to provide Neonatal resuscitation.

Neonatal survival is relative to the level of accessible

Of the three essential functions key to the survival of the

neonatal care in a community

1-2

and the availability of

Newborn, respiration is of prime importance. Thus ca-

neonatal intensive care has improved the outcomes of

pacity for and availability of ventilator support is key in

high-risk infants.

3-7.

the provision of any form of life support system or in-

Neonatal care in Nigeria has improved significantly

tensive care for sick new-borns. The other two functions

from the early 1970s when only six teaching hospitals

of feeding and thermal support can be provided through

offered such services. Currently, a large number of fa-

adaptations that include gavage enteral feedings of ex-

cilities provide similar services in different locations in

pressed breast milk and Kangaroo mother care.

the country. The quality of care provided by these cen-

Level 1: Basic care unit – provides evaluation and

tres are, however, not uniform. Hitherto, there has been

postnatal care of healthy new-born infants; and

no attempt to classify these centres according to the

Phototherapy; Care for infants 34-35W>1800gm with

level of services offered.

mild illness and these units can initiate IV lines,

administer and monitor Oxygen saturation

Neonatal care facilities should be classi fied on the basis

Level 2: Special care new-born nursery

of functional capabilities, and should be organized

Cares for infants of greater than 32 weeks gestation or a

8-11

within a regionalized system of perinatal care

. In the

weight of 1500 g or greater who are moderately ill; they

current context, Neonatal intensive care unit (NICU) is

can provide CPAP, Intravenous infusion, and possibly

specialized in the care of ill new-borns and manned by

the use of umbilical central lines.

9

Level 3: Intensive neonatal care unit

spondent, information about their practice location, neo-

Provides: care for very ill infants of all gestational ages

natal unit capacity, personnel, trainings in newborn

and weights; Mechanical ventilation (MV) support, for

cardio-pulmonary resuscitation and maintenance of car-

as long as required and immediate access to the full

diovascular stability, equipment’s available for key sup-

range of subspecialty consultants. Ability to monitor

port of critically ill neonates, especially for newborn

fully the critically ill new-born using multi-parameter

thermal control, respiratory support cardiovascular stabi-

monitors and to measure Arterial Blood gasses (ABG).

lization and monitoring devices for care and support of

This definition is adapted from the AAP guidelines to

babies on these interventions was administered to atten-

meet with available resources in a developing commu-

dees. Information on parenteral alimentation was not

nity. This standard of tiered level of neonatal services as

sought for neither were issues on modalities of case

contained in the policy statement of the American Acad-

management sought after.

emy of Pediatrics and utilized in developed communi-

8

The availability of surfactant replacement service was

ties is yet to be applied in Nigeria.

also solicited. The responses were weighted according to

the status of the respondents and completeness of solic-

Classification of newborn care services is key to im-

ited information. Consultant with neonatal training were

proving neonatal survival as this offers the opportunity

considered key informants.

of enhanced referral of high-risk patients to higher-level

The care facilities were classified according to the level

centres with the appropriate resources for complexity of

of sophistication of services available using the AAP

criteria for categorization of levels of care. The data

8

care. A documentation of the services provided by dif-

8

ferent neonatal units in the country is helpful in estab-

gathered were entered into an IBM/ SPSS spreadsheet

lishing the scope and quality of available newborn care.

and analyzed.

Quality of newborn care by level of services offered is a

critical determinant of neonatal outcomes.

1-2

Aim

Results

To ascertain the scope and classify the quality of new-

A total of 250 questionnaires were distributed during the

born services available at major Nigerian hospitals.

conference and 237 were returned. The return rate of the

questionnaires was 94.8%.The respondents comprised

Specific Objectives:

doctors and nurses working in Paediatric and Neonatal

1.

To ascertain the standard of neonatal services avail-

facilities in Nigeria. There were 90 (38.0%) males and

able at major hospitals

147 (62.0%) females.

2.

To categorize these services by level of available

The geopolitical regions of the 237respondents are as

resources for Neonatal care

follows: South-South 59(24.9%), South-East

85(35.9%), South-West 30(12.7%), North-Central 43

(18.1%), North-East 3(1.3%), North-West 10(4.2%), No

response 7(3.0%); whilst 218(92.0%) were Christians

Methods

and 16(6.8%) Muslims. Other characteristics of the re-

Study Design

spondents are shown in Table 1.

A questionnaire based descriptive study was conducted

Table 1: General Characteristics of the Respondents

Validation of the questionnaire

Characteristics

Number (%)

Total (%)

Doctor

Consultant

96 (40.5)

After the development of the questionnaire, it was field

Senior Registrar

59 (24.9)

tested with medical students, nurses and midwives,

Registrar

35 (14.8)

Medical Officer

11 (4.6)

201 (84.8 )

house officers, resident doctors and consultants in the

Nurse

ADNS

5 (13.9)

Department of child health. This was to ensure validity

CNO

5 (13.9)

of the responses and questions for which the answers

ACNO

5 (13.9)

were not reproducible were eliminated.

SNO

8 (22.2)

NO-I

1 (2.8)

NO-II

12 (33.3)

36 (15.2)

Ethical Considerations

Type of practice

Public

208 (87.8)

Private

26 (11.0)

The study proposal was approved by the ethical commit-

No response

1 (1.2)

Level of practice

Primary

5 (2.1)

tee of the University of Benin Teaching hospital.

Secondary

26 (11.0)

At the 2015 edition of the Pediatric Association of

Tertiary

199 (83.9)

Nigeria (PAN) Conference that held in Abakaliki,

No response

7 (3.0)

Ebonyi state, after the general information of the essence

of the study was explained to the participants, informed

ADNS: Assistant Director of Nursing services, CNO: Chief

consent was obtained and the willing participants ac-

Nursing Officer, ACNO: Assistant Chief Nursing Officer,

cepted to fill out the anonymous questionnaire.

SNO: Senior Nursing Officer, NO: Nursing Officer.

The

validated semi-structured questionnaire that as-

sessed basic social demographic information of the re-

Of the thirty six states of the federation and Abuja, Pae-

diatric and Neonatal personnel from twenty nine states

10

returned the questionnaires. The states without respon-

Table 3: Respondents location by Unit capacity, Level, Type and

dents were Adamawa, Bauchi, Benue, Jigawa, Niger and

Respiratory support capacity of Neonatal units

State

City

Respon-

Leve

Type of

Bed

Respira-

Level

Yobe; hence their neonatal care services were not as-

dent(s)

l of

Practice

Capac-

tory

sessed. These states are in the North-East, North-Central

care

ity

support

available

and North-West geopolitical regions of the country.

3

0

Kaduna

Zaria

3

Public

30

Full

II

3

0

Table 2 Shows the location of respondents (states &

Kano

Kano

1

Public

38

Full

II

3

0

Katsina

Katsina

1

Public

24

Partial

II

cities), the functional and other details of their neonatal

3

0

Kogi

Lokoja

4

Public

18

-

I

units. The respiratory support capability of the units

3

0

Kwara

Ilorin

2

Public

35

Full

II

3

0

consisted of (Full Mechanical Ventilation (MV) Capac-

Lagos

Ikeja

5

Public

50, 30

Full

II

1

0

Idi-Araba

80

Full

II

ity; Availability of MV and Continuous positive Airway

2

0

Mainland

8

-

I

1

0

pressure [CPAP]. Partial Capacity; as defined by Stand-

Isolo

Private

13

Full

III

3

0

Others

7

Private

3-13

Full

II

3

0

alone CPAP only available). These information facili-

Nasa-

Keffi

6

Public

25

-

I

rawa

tated the categorization of the proposed level of neonatal

3

0

Ogun

Abeokuta

3

Public

40

-

I

3

0

care.

Shagamu

Public

28

-

I

2

0

Ondo

Akure

3

Public

25

-

I

3

0

Table 2: Respondents location by Unit capacity, Level, Type

Owo

Public

16

-

I

3

0

Osun

Oshogbo

Public

28

-

I

and Respiratory support capacity of Neonatal units.

3

0

Ile-Ife

Public

25

Full

II

3

0

State

City

Respon-

Level

Type of

Bed

Respira-

Level

Ilesha

Public

20

-

I

3

0

dent(s)

of

Practice

Capac-

tory

Oyo

Ibadan

4

Public

40

Full*

II

3

0

care

ity

support

Ogbo-

-

Public

25

-

I

available

mosho

3

0

3

0

Abia

Umuahia

11

Public

30, 18

Partial

II

Plateau

Jos

1

Public

15

Full

II

3

0

2

0

Aba

-

Public

24

-

I

Rivers

P/H

11

Public

30, 45

Full*

II

3 ǂ

0

3

0

Akwa

Uyo

1

Public

45

-

I

P/H

3

Private

4

I

2 ǂ

0

Ibom

Bonny

1

Private

2

Full

II

3

0

Anam-

Awka

11

Public

16

-

I

island

3

0

bra

Nnewi

-

Public

30,45

Full*

II

3

0

Sokoto

3

Public

25

Full

II

3 ǂ

0

Zamfara

Sokoto

3

Public

10, 30

Full

I

3

0

Bayelsa

Yenogoa

2

Public

14,

-

I

2

0

Gusau

Public

10

Partial

II

3

0

Borno

Maiduguri

1

Public

22

Full

II

3

0

FCT

Abuja

23

Public

20-60

Partial

II

3

0

3

0

Cross

Calabar

4

Public

35

-

I

G/wlada

-

Public

40

Full

I

2 ǂ

0

River

Abuja

7

Public

10,12,2

Partial

II

2 ǂ

0

3

0

Delta

Asaba

19

Public

20

Partial

I

Private

7-20

Full

III

Abuja

2

0

Warri

4

Public

20

-

I

No

2

0

-

Private

5

Partial

II

Response

9 (3.8)

10 (4.2)

4 (1.7)

(%)

3

0

Oghara

-

Public

20

Full

III

3

0

Ebonyi

Abakaliki

33

Public

30

-

I

*available none functional MV, P/H = Port Harcourt

3

0

Edo

Benin City

14

Public

50

Full

III

G/Wlada = Gwagwalada

2

0

Irrua

-

Public

Full*

I

3

0

Public

23

-

I

3

0

Ekiti

Ado- Ekiti

4

Public

15

-

I

Only 20 (37%) of facilities were located outside the state

3

0

Ido- Ekiti

Public

37

-

I

3

0

Enugu

Enugu (1)

21

Public

50, 40

Full

III

capitals; while 7 (13%) were private outfits. The capac-

Enugu (2)

35, 20

-

I

3

0

Gombe

Gombe

2

Public

18

Full

II

ity to offer one form or the other of respiratory support

3

0

Imo

Owerri

9

Public

40, 20

Full*

II

partially or full was available in more than 60%of the

Orlu

21

I

facilities surveyed.

The neonatal unit capacities ranged from 2-80 cots. The

Although in the public sector, tertiary were in the major-

private health facilities have smaller neonatal units (<5

ity, half 27 (50%) of the units belonged to level I, 22

cots) and the largest private unit have 20 cots spaces.

(40.7%) level II, and 5 (9.3%) level III class of neonatal

The public tertiary facilities have units ranging from 14-

care. The highest proportion of level I units 10 (37%)

80 cot capacity. All units above 30 cots capacity are in

were in the SW region, level II 5 (22.7%) also in the

public tertiary health facilities.

SW, while level III units 2 (40%) were in the SS region.

The 54 health institutions of these respondents were

Three (60%) of the level III units are public facilities

headed by a neonatal Paediatrician.

while 2 (40%) are private healthcare facilities.

The distribution of the respondents units by the geopolitical

The details of the Neonatal resuscitation training of re-

regions, type and level of practice, and their respiratory sup-

spondents who are doctors are shown in Table 5.

port capacity are shown in Table 4.

Table 4: Geopolitical distribution of the respondent units by Respiratory support

Neonatal Resuscitation training information were omit-

capacity and Level of neonatal care.

ted by 9 (4.5%) of the doctor respondents, 164 (81.6%)

Geopolitical n

Capital

Public

Partial

Full

Level (%)

were trained on Neonatal resuscitation. Senior residents

Region

(%)

City (%)

(%)

(%)

(%)

I

II

III

S-S

13(24.1)

8(61.5)

10(76.9)

4(30.8)

5(38.5)

8(61.5)

3(23.1)

2(15.4)

were the highest 49 (89%) and Medical officers the least

S-East 9(16.7)

6(66.7)

9(100.0)

2(22.2)

3(33.3)

5(55.6)

3(33.3)

1(11.1)

4 (40%) trained. For the Nurse respondents, 3 (8.3%)

S-West 16(29.6)

7(43.8)

13(81.3)

4(25)

6(37.5)

10(62.5)

5(31.2)

1(6.3)

did not provide the Neonatal Resuscitation training in-

N-Central 8(14.8)

6(75.0)

7(87.5)

3(37.5)

3(37.5)

3(37.5)

4(50.0)

1(12.5)

formation. Less than two thirds 22 (61.1%) were trained

N-East 2(3.8)

2(100)

2(100)

2(100)

2(100)

-

2 (100)

-

on Neonatal resuscitation.

N-West 6(11.1)

5(83.3)

6(100)

2(33.3)

4 (66.7)

1(16.7)

5(83.3)

-

54

4 (63)

47 (87)

17 (31)

23

7(50)

22(40.7)

5(9.3)

The distribution of the training among the different

(42.6)

cadre of Nurses is shown in Table 5.

ǂ Units offering multiple level of care. ٭ Nonfunctional MV equipment.

11

Table 5: Neonatal Resuscitation training of Respondents

(55.6%) units are level III, while 4 (44.4%) are level II

Health

n

Trained

NRT

HBB

NRT/

Others

neonatal care facilities.

personnel

(%)

HBB

Doctors

Table 7: Respondents location by Pulse oximeter, Multi-

Consult-

92

82 (89.1)

43

4

32

3

parameter monitors, ABG, and Surfactant services availability.

ants

Location City Pulse n(%) Multi-parameter ABG

Surfactant

Residents

90

78 (86.7)

61

2

14

1

n

oximeters

monitors n(%)

n (%) services n(%)

Medical

10

4 (40)

4

-

-

-

SS

13

13 (100)

6(46.2)

4 (30.7)

3 (23.1)

Officers

SE

9

9 (100)

4(44.4)

- (0.0)

2 (22.2)

No re-

9

SW

16

16 (100)

4(25.0)

1(6.3)

3 (18.8)

sponse

NC

8

8 (100)

6(75.0)

1(12.5)

1 (12.5)

Sub-Total

20

164

108

6 (3.7)

46

4 (2.4)

NE

2

2 (100)

1(50.0)

- (0.0)

- (0.0)

1

(81.6)

(65.9)

(28.0)

NW

6

6 (100)

2(33.3)

- (0.0)

- (0.0)

Nurses

54

54 (100)

23(42.6)

6(11.1)

9 (16.7)

Senior

15

11 (73.3)

9

1

1

-

Cadre

NO. Cadre

18

11 (61.1)

9

1

1

-

No re-

3

9

-

sponse

Sub-Total

36

22(61.1)

18

2 (9.1)

2 (9.1)

Discussion

(81.2)

Neonatal care in Nigeria has made progress. This assess-

Of the 201 doctor respondents, 181 (90%) indicated

ment highlights availability and scope of services pro-

their Neonatal Ventilation training information out of

vided in neonatal units in Nigeria, each functioning at

which 71 (39.2%) were trained. Consultants 42 (51.2%)

different levels of sophistication. The response rate of

are the highest trained cadre and the medical officers the

95% was much higher than a similar survey in the US .

12

least 1(11.2%) trained on neonatal mechanical ventila-

The respondents comprising mostly of doctors (85%)

tion.

and female health workers, reflecting the composition of

There is a significant relationship between increasing

participants at this conference. The nurses’ respondents

level of paediatric specialization and mechanical ventila-

(15.2%) maybe reflective of interest in knowledge up-

tion training as shown in table 6.

date of pediatric care and development.

Out of 36 Nurse Respondents, 32 (88.9%) completed

As expected, more of the respondents (35.9%) were

their Neonatal ventilation training information. Only 6

from the South-East (SE) states due to proximity to the

(18.8%) of them are trained with Nursing Officers II

conference location while the least (1.3%) were from the

(NO-II) being the highest 4 (40%) trained cadre and the

North East (NE) states which is farther away. The rela-

Assistant Director of Nursing services (ADNS) and

tively high representation of the Neonatal facilities lo-

Chief Nursing Officers (CNO) being the cadre without

cated in in the South West may be a true reflection of

Neonatal ventilation training. This is shown in Table 6.

the availability of neonatal services in that region. The

paucity of respondents and facilities from the NE region

Table 6: Neonatal Ventilation Training of Respondents

may be due to the restriction of movement in that region

Health Staff

n

Mechanical Ventilation Training

as a result of insurgency activities. It may also be due to

Yes(%)

No(%)

Doctors

redistribution of Pediatric specialists from that region to

Consultants

86

42 (48.8)

44 (51.2)

other regions due to security concerns.

Resident Doctors 86

28 (32.6)

58 (67.4)

χ2 9.15, p 0.025

Medical officer

9

1 (11.1)

8 (88.9)

That most (87.8%) neonatal units were from public and

181

71 (39.2)

110 (60.8)

Nurses

tertiary healthcare facilities (83.9%) may be a true re-

Senior Cadre

14

1 (7.1)

13 (92.9)

flection of the current prevailing national circumstances

NO. Cadre

18

5 (27.8)

13 (72.2)

where highly specialized and cost intensive services are

32

6 (18.8)

26 (81.2)

provided by public sector.

The total number of neonatal ventilators available in the

The fact that many of these hospitals are located in state

newborn units evaluated were 38, located in 23 of the 54

capitals calls for an urgent need to establish networks in

units. The private units have7 (18.4%) while the public

the periphery so as to reduce mortality and morbidity in

communities

13,14

units have 31(81.6%) of the neonatal ventilators. State

.

capitals were the location of 14/22 (63.6%) and 24/38

(63.2%) of the ventilators. They were most commonly

Neonatal Mechanical ventilators were available in only

available in the SW and SS 11(28.9%) and least avail-

half of the centers evaluated with the highest proportion

able in the NE 2 (5.2%). This is shown in Tables 8 & 9.

being in the south West; this highlights the need for es-

Pulse oximeters were available in all (100%) the neona-

tablishment of such services in its simplest form

tal units, multi-parameter monitors in 23 (42.6%) while

throughout the country, whilst more sophistication could

6 (11%) have ABG machines. Four (66.67%) of the

be made available at the regional levels. The regionali-

ABG machines were located in the SS region. Surfactant

zation of services has been linked to neonatal mortality

reduction in Europe and North America

1,5,15,16

replacement services are available in 9 (16.7%) of the

.

units evaluated. For 4 (44.4%) of these units, surfactant

replacement services were provided on request. Five

12

The existence of level I neonatal units or basic care

ability of neonatal MV. MV services are available in

level II neonatal units in developed countries hence the

8

nurseries in teaching hospitals is a misnomer for facili-

ties that ought to give specialized care to referred cases.

drift from MV availability to ventilation strategies or

techniques.

17

Basic or level I neonatal care centers ought to be located

in primary health centers or secondary care facilities. So

that they can provide newborn resuscitation, optimal

It’s noteworthy that some of the neonatal units with MV

postnatal care for every delivery and stabilization of ill

capacity (40.7%) may be suitable for NICU or level III

babies before transport to level II or III facilities. When

care. The number of units 5 (9.3%) with level III neona-

tertiary centers cater for level I or II care, chances are

tal care are appalling hence the dire need to establish

that the newborn services are non-existent in primary or

Regional neonatal centres as centres to provide full

secondary care centers. This may be responsible for the

range of care.

poor quality of neonatal services with the attendant high

neonatal morbidity and mortality in the country.

All the centers have pulse oximetry capacity, while a

quarter (25%) have multi-parameter monitors and only

It’s interesting to note the disproportionate distribution

11% had ABG machines. This shows poor neonatal

of higher levels of neonatal care in the south with only

monitoring infrastructure in the facilities evaluated.

one level III neonatal unit in the North central region.

Critical care decision are dependent on the ability to

This finding may reinforce the quest for regional care

anticipate biochemical abnormalities and confirm

centres in targeted hospitals and scaling up of neonatal

1,5

promptly using these monitoring tools for informed in-

terventions. Paucity of monitoring tools may be a con-

services in the primary and secondary centres which are

tributory factor to the reduced survival of very ill new-

either non-existent or not functional.

borns in the units. The paucity of surfactant replacement

services reduces chances of survival of ELBW and

VLBW babies,

5,18

Most of the doctors at this conference were trained on

whichcontributes to the high National

Neonatal resuscitation through one form of training or

neonatal mortality.

the other; NRT being the most common is a reflection of

the availability of this training annually during the PAN

This study is has attempted to describe the scope and

conference.

quality of neonatal care available in major Nigerian hos-

A reasonable proportion of the nurses were trained on

pitals. It is limited in the sense that it did not assess for

neonatal resuscitation however, the finding that more

sophisticated care such as the availability of parenteral

than one third of nurses were untrained in neonatal re-

alimentation or further sophisticated means of manage-

suscitation is worrisome albeit the lowest cadre being

ment of encephalopathies such as cooling devices and

the most trained. This portends a negative influence on

techniques. However in the assessment, focus was

neonatal survival as more deliveries are supervised by

placed rather on what was considered simpler means of

nurses. The nursing staff are key to the implementation

14

management by the authors such as respiratory support

of community based neonatal care at the hinterlands

which had played a major role in the drastic reduction in

where the delivery of babies needing bag-mask-valve

neonatal mortality in the developed countries. This is

resuscitation mostly occurs. Neonatal resuscitation train-

because prior to the introduction of ventilator support in

ing should be stepped down to nurses in the primary

Europe and North America, the neonatal mortality could

centres as a matter of urgency.

not reduce further than below 35 per thousand live

births . The introduction of ventilator support drove the

18

Half of doctors that have been trained on neonatal MV

reduction in neonatal mortality. All the respondents uni-

are consultants; the medical officers have the fewest

formly had available means of thermal regulation

proportion of trained personnel. This finding ought to

through the use of incubator care even though the quan-

translate to a highly skilled and responsive neonatal sur-

tity of incubators to the ratio of babies catered for was

vival systems and teams in the different centres. How-

not estimated. The ratio of support health personnel to

ever this was not verified in this study.

patient was equally not assessed.

Only few of the nurses were trained in neonatal MV,

The findings from this study is far below what is found

with the lowest cadre being the most trained group a

in developed countries of Europe , North America and

reversal of the trend observed among doctors. This find-

south Africa where Standard level of Intensive care

ing is thought provoking as skilled medical and nursing

Units are available and these countries can provide for

personnel is key to successful mechanical ventilation

the various levels of care ranging from level 1 to level 3

service. This maybe one of the reasons for the unavail-

to 4. In most countries of Africa there is scarcity of pub-

ability and non-commencement of this service in some

lished data on the tiered system of care. In other coun-

tertiary hospitals evaluated.

tries of West Africa like Ghana, there is the capacity for

the provision of level 1,2 and one or two level 3 hospi-

The finding of slightly above one third of tertiary neona-

tals. In Countries of East Africa where there may be

tal centres having MV facilities is a reflection of the

paucity of level 3 neonatal care services, there is scarcity

poor neonatal infrastructural capacities. There are no

of published data on the tired care. It is therefore appar-

similar publications known to the authors from resource

ent that the level of available care is driven by the avail-

poor and high neonatal mortality settings on the avail-

able resources allocable to the health care services.

13

Despite the limitations of this survey, it has given an

cities. Such basic neonatal care is scarce in the commu-

indication of the impact of allocation of limited resource

nities

to health care services in general and more importantly

the effect of none prioritization of neonatal care in the

Recommendations

scope of maternal and child care. Health sector funding

should therefore be refocused with emphasis placed on

More in-depth Assessment should provide for evaluation

the improved funding of hospitals as the panacea for

of availability of feeding modalities

better scope and quality of neonatal care services.

More resources should be allocated to health to ensure

provision of improved neonatal health care resources

Funding does not have to come strictly from government

Regionalization of higher level care, networking and

directly. It could come from private investors, from vari-

community linkage may be the panacea for the prevent-

ous sectors of the economic community but there should

able deaths and diseases of newborn babies.

be a well-coordinated mechanism for this source of

funding to ensure a sustainable source. Such funding

Limitations

source could come from some foundations or compa-

nies. Various innovative means could be focussed upon

The study did not evaluate for sophisticated care such as

and stake holders can focus on exploring creative means

the availability of parenteral alimentation or further

of identification of sustainable funding mechanisms for

sophisticated means of management of encephalopathy

health sector and neonatal health.

such as cooling devices and techniques or the admini-

stration of Nitric Oxide.

Conflict of interest: None

Conclusion

Funding: None

Neonatal care in Nigeria is still in evolution. The peak of

the medical personnel are skilled but the lower medical,

Acknowledgements

senior and intermediate nursing care staff are unskilled

for critical neonatal care service. Basic neonatal care is

The Authors gratefully acknowledge the co-operation of

widespread in major public and private centers in major

all the respondents to the questionnaire for taking of

their valuable time to complete the questionnaire

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