P2B083: The Delivery of Essential Newborn Care in Conflict Settings: A Systematic Review

Background: Although progress has been made over the past 30 years to decrease neonatal mortality rate, reductions have been uneven. Globally, the highest neonatal mortality rates are concentrated in countries chronically affected by conflict. Essential Newborn Care (ENC), which comprises key therapeutic interventions for every newborn, such as thermal care, initiation of breathing, feeding support, and infection prevention, is one strategy to decrease neonatal mortality in humanitarian settings. Understanding the barriers to and facilitators of ENC delivery within conflict settings is an important first step to strengthening the implementation of ENC. In this systematic review, we explored how ENC is delivered in conflict settings, with a focus on understanding the barriers to and facilitators of ENC implementation.

Methods: We performed systematic literature searches of Ovid/MEDLINE, Embase, CINAHL, and Cochrane databases using terms related to newborns, conflicts, components of essential newborn care. Grey literature was also reviewed from the Healthy Newborn Network and a number of international non-governmental organization (NGO) databases. We included original research on conflict-affected populations that primarily focused on ENC delivery. Information on population, study design, and delivery characteristics were extracted and synthesized, and quality assessment of the included studies was performed.

Results: A total of 1,533 abstracts were screened and ten publications met the eligibility criteria for final review. Several barriers emerged from the reviewed studies and were subdivided by barrier level: patient, staff, facility, and humanitarian setting. Patients faced barriers 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.

Conclusion: Strategies for improved ENC implementation include improving maternal knowledge of newborn danger signs, training providers on high-impact immediate ENC behaviors, and increasing facility readiness through upgrades in infrastructure, guidelines, and health information systems. Community-based strategies may also be important in strengthening ENC.