Table_1_Improving the quality of neonatal health care in Ethiopia: a systematic review.DOCX

BackgroundEnsuring high-quality healthcare for newborns is essential for improving their chances of survival within Ethiopia's healthcare system. Although various intervention approaches have been implemented, neonatal mortality rates remain stable. Therefore, the present review seeks to identify initiatives for enhancing healthcare quality, their effects on neonatal wellbeing, and the factors hindering or supporting these Quality Improvement (QI) efforts' success in Ethiopia.
MethodsWe searched for original research studies up to June 23, 2023, using PubMed/Medline, WHO-Global Health Library, Cochrane, Clinical Trials.gov, and Hinari. After selecting eligible studies, we assessed their quality using a mixed-method appraisal tool. Quality of care refers to how healthcare services effectively improve desired outcomes for individuals and patient populations. It encompasses vital principles such as safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness.
ResultsWe found 3,027 publication records and included 13 studies during our search. All these interventions primarily aimed to provide safe healthcare, with a strong focus on Domain One, which deals with the evidence-based routine upkeep and handling of complications, and Domain Seven, which revolves around ensuring staff competency, emerged as a frequent target for intervention. Many interventions aimed at improving quality also concentrate on essential quality measure elements such as processes, focusing on the activities that occur during care delivery, and quality planning, involving distributing resources, such as basic medicine and equipment, and improving infrastructure. Moreover, little about the facilitators and barriers to QI interventions is investigated.
ConclusionsThis review highlights the significance of introducing QI initiatives in Ethiopia, enhancing the healthcare system's capabilities, engaging the community, offering financial incentives, and leveraging mobile health technologies. Implementing QI interventions in Ethiopia poses difficulties due to resource constraints, insufficient infrastructure, and medical equipment and supplies shortages. It necessitates persistent endeavors to improve neonatal care quality, involving ongoing training, infrastructure enhancement, the establishment of standardized protocols, and continuous outcome monitoring. These efforts are crucial to achieving the optimal outcomes for newborns and their families.

背景
在埃塞俄比亚的医疗体系中，为新生儿提供高质量的医疗服务，是提升其生存几率的核心要义。尽管已落地多种干预方案，但新生儿死亡率仍维持在稳定水平。因此，本综述旨在梳理可用于提升医疗服务质量的相关举措、这些举措对新生儿健康福祉的影响，以及在埃塞俄比亚境内阻碍或助力这些质量改进（Quality Improvement, QI）工作取得成功的各类因素。
方法
我们于2023年6月23日前，通过PubMed/Medline、WHO全球健康图书馆（WHO-Global Health Library）、科克伦（Cochrane）、临床试验.gov（Clinical Trials.gov）以及Hinari数据库检索原创研究文献。在筛选出符合纳入标准的研究后，我们采用混合方法评价工具对研究质量进行评估。医疗服务质量指的是医疗服务如何有效提升个体及群体患者的预期结局，其涵盖安全、有效、及时、高效、公平以及以患者为中心等核心原则。
结果
本研究共检索到3027条文献记录，最终纳入13项研究。所有纳入的干预举措均以提供安全的医疗服务为核心目标，其中领域一（针对基于证据的常规护理与并发症处置）与领域七（聚焦保障医护人员胜任力）是最常见的干预靶点。多数旨在提升医疗质量的干预举措，还聚焦于医疗质量评价的核心要素：包括以护理实施过程中的活动为核心的流程要素，以及涉及调配基本药品、设备等资源并完善基础设施的质量规划要素。此外，针对质量改进（QI）干预举措的推动因素与阻碍因素的相关研究仍较为匮乏。
结论
本综述凸显了在埃塞俄比亚推行质量改进（QI）举措的重要意义，具体包括强化医疗体系能力、动员社区参与、提供经济激励以及运用移动医疗技术。在埃塞俄比亚实施质量改进干预举措面临诸多困难，具体体现为资源匮乏、基础设施不足以及医疗设备与耗材短缺。为此，需持续发力以提升新生儿护理质量，包括开展常态化培训、完善基础设施、制定标准化诊疗规范以及开展持续的结局监测。这些工作对于实现新生儿及其家庭的最优健康结局至关重要。