In Ethiopia, 28 of every 1,000 babies die within their first 28 days of life, a stark contrast to an infant mortality rate in the United States and other high-income countries of about four deaths for every 1,000 live births.
The Ethiopian Pediatric Society and the country’s Ministry of Health want to cut those infant death rates to 12 per 1,000 by 2030 to reach the UN’s Sustainable Development Goals, and they have turned to the Vermont Oxford Network
(VON) for help. VON, based in Burlington, collects data from neonatal intensive care units to find ways to improve the quality of care for newborns.
Through VON’s global health program, its volunteers have provided training and support to Ethiopian healthcare professionals for more than a decade. In 2012, VON trained three neonatologists – the first ever in Ethiopia to specialize in intensive care for newborns. The Ethiopian Neonatal Network, launched with VON’s guidance, now includes 28 hospital members.
In 2017, Ethiopia became the first low-income country to join VON. Until then, the network’s membership came from high- and middle-income countries, leaving a gap in data from countries with fewer resources, says Danielle Ehret, M.D., M.P.H., associate professor of pediatrics at the UVM Larner College of Medicine and VON’s director of global health.
“The opportunity to contribute to the dynamic field of global neonatal health is amazing,” says Ehret, who specializes in neonatal medicine. “One of VON’s goals is to close the data gap and the quality improvement gap in neonatal care worldwide.”
VON’s work in Ethiopia caught the attention of the Bill & Melinda Gates Foundation, which works to help all people lead healthy, productive lives. Ehret has received funding from the Bill & Melinda Gates Foundation for a Phase I study to better understand the landscape of neonatal care for premature, or preterm, babies in Ethiopia. In particular, they want to learn more about the NICU environment and currently available treatments for respiratory distress syndrome (RDS) - the main cause of death for preterm babies in Ethiopia - and identify opportunities for improvement.
Given the burden of RDS, currently reported as the cause of death in approximately half of the preterm deaths in Ethiopian NICUs, VON has also been selected to provide clinical training and guideline development for the country. The Ethiopian Federal Ministry of Health and UNICEF have given VON funding to train Ethiopian providers on how to use nasal CPAP, or continuous positive airway pressure, which is the most effective treatment for RDS currently available in the country. It can save up to 70 percent of babies with RDS.
VON sent a volunteer team – including doctors, nurses, nurse practitioners and respiratory therapists – to work with supercoaches in Ethiopia to develop CPAP treatment guidelines, empower nurses, and train staff in 13 additional hospitals.
“The hope is that the availability of CPAP will continue to spread,” Ehret says.
Founded more than 30 years ago by UVM neonatologist Jerold Lucey, M.D., Vermont Oxford Network is the largest data clearinghouse of its kind devoted to information about critically ill newborns. The network now includes more than 1,300 neonatal intensive care units in 32 countries. They include nurses and nurse practitioners, pharmacists, respiratory therapists, social workers, families and physicians. Among babies born in the United States with birth weights less than 1,500 grams, more than 90 percent are under the care of NICU members of VON.
“NICUs are springing up all over the developing world,” says Jeffery Horbar, M.D., professor of pediatrics at UVM and VON’s chief executive and scientific officer. “Learning what the proper resources and approaches to NICU care should be in resource-constrained countries is extremely important.”
VON’s work in Ethiopia is ongoing, bolstered by continuous analysis of the country’s data.
“We know from experience that having the data paired with quality improvement education are two main ingredients for success,” Ehret says. “This has been done mostly in high-income countries and in very well-resourced neonatal intensive care units, but those same principals could be applied to many different settings. The benefits would likely even be greater in a low-resourced setting, making small no-cost or low-cost changes, and thinking about how we can look at the system in a different way.”