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  1. 1. Introduction
    1. 1.0 Vue d'ensemble
    2. 1.1 Quel est le but du guide de terrain
    3. 1.2 A qui s'adresse le guide de terrain ?
    4. 1.3 Comment le guide de terrain est-il organisé ?
  2. 2. Background
    1. 2.0 Vue d'ensemble
    2. 2.1 Les contextes humanitaires à travers le monde
      1. 2.1.1 Défis pour la prestation de services de santé aux nouveau-nés
    3. 2.2 La santé du nouveau-né : Epidémiologie
      1. 2.2.1 Charge mondiale de la mortalité néonatale
      2. 2.2.2 Principales causes de décès néonatals
  3. 3. Services de santé néonatale
    1. 3.0 Vue d'ensemble
    2. 3.1 Principes généraux et considérations
      1. 3.1.1 Le continuum de soins tout au long de la vie
      2. 3.1.2 Niveaux de soins
    3. 3.2 Les soins essentiels du nouveau-né
    4. 3.3 Soins aux nouveau-nés au niveau des ménages/de la communauté
      1. 3.3.1 Pendant la période prénatale
      2. 3.3.2 Soins intra-partum et soins essentiels aux nouveau-nés
      3. 3.3.3 Soins postnatals
    5. 3.4 Soins aux nouveau-nés dans les établissements de soins primaires
      1. 3.4.1 Soins prénatals
      2. 3.4.2 Soins intrapartum et soins essentiels au nouveau-né
      3. 3.4.3 Soins postnatals
    6. 3.5 Soins aux nouveau-nés dans les hôpitaux
      1. 3.5.1 Soins prénataux
      2. 3.5.2 Soins intra-partum et soins essentiels au nouveau-né
      3. 3.5.3 Soins postnatals
    7. 3.6 Considérations supplémentaires pour la prévention et la gestion des principales causes de décès néonatals
      1. 3.6.1 Prématurité/Petit poids de naissance (PPN)
      2. 3.6.2 Infections du nouveau-né
      3. 3.6.3 Complications intra-partum
  4. 4. Considérations stratégiques
    1. 4.0 Vue d'ensemble
    2. 4.1 Intégration de la santé des nouveau-nés dans la coordination humanitaire
      1. 4.1.1 Intégrer des questions sur les services de santé néonatale dans une évaluation rapide de la santé.
      2. 4.1.2 Plaider pour l'inclusion et la priorisation de la santé des nouveau-nés dans les plans d'intervention humanitaire.
    3. 4.2 Conduire une analyse situationnelle
      1. 4.2.1 Examiner les politiques et protocoles nationaux relatifs à la santé des nouveau-nés
      2. 4.2.2 Examiner les directives cliniques, les messages clés/les supports de CCC, les outils et les supports de formation existants
      3. 4.2.3 Évaluer la disponibilité des ressources : installations, fournitures et personnel
    4. 4.3 Développer une stratégie de réponse inclusive et unifiée
      1. 4.3.1 Prioriser les interventions auprès des nouveau-nés
      2. 4.3.2 Actualiser et distribuer les directives et protocoles cliniques
      3. 4.3.3 Développer et rassembler les matériels de formation du personnel en fonction des besoins
      4. 4.3.4 Procure et distribue les médicaments et fournitures essentiels
      5. 4.3.5 Assurer l'amélioration de la qualité et le respect des soins
      6. 4.3.6 Élaborer des propositions pour obtenir des fonds supplémentaires
    5. 4.4 Développer et mettre en œuvre un plan de suivi et d'évaluation (S&E)
      1. 4.4.1 Compromis dans le flux de données et les systèmes d'information de routine
  5. 5. Considérations sur la mise en œuvre du programme
    1. 5.0 Vue d'ensemble
    2. 5.1 Développer et diffuser des messages clés/matériels de communication pour le changement de comportement (CCC)
    3. 5.2 Développer un système de référence
      1. 5.2.1 Quand la référence n'est pas possible
    4. 5.3 Visites à domicile pour les mères et les bébés
    5. 5.4 Fourniture de kits de soins aux nouveau-nés
    6. 5.5 Gestion des décès de nouveau-nés dans les situations de crise
      1. 5.5.1 Soutien en cas de perte néonatale
      2. 5.5.2 Documenter la perte néonatale
  6. 6. Annexes
    1. 6.1 Annexe 1 : Tableaux récapitulatifs des services de santé du nouveau-né par niveaux de soins
      1. 6.1.1 Annex 1A
      2. 6.1.2 Annex 1B
      3. 6.1.3 Annex 1C
    2. 6.2 Annexe 2 : Doses de médicaments courants pour les nouveau-nés
    3. 6.3 Annexe 3 : Soins avancés pour les nouveau-nés très malades
    4. 6.4 Annexe 4 : Outils d'aide à l'orientation vers les services néonatals
      1. 6.4.1 Annexe 4A : Quand référer un nouveau-né à l'hôpital
      2. 6.4.2 Annex 4B : Aide-mémoire : Transport du nouveau-né malade
      3. 6.4.3 Annex 4C : Sample Referral Note
    5. 6.5 Annexe 5 : Kits pour nouveau-nés dans les situations humanitaires
    6. 6.6 Annexe 6 : Indicateurs
      1. 6.6.1 Annexe 6A : Indicateurs de la santé du nouveau-né pour les systèmes de données de routine
      2. 6.6.2 Annexe 6B : Liste des indicateurs et des questions permettant de mesurer la capacité des établissements à fournir des services clés de santé néonatale
  7. 7. In Practice
    1. 7.1 Uganda
      1. 7.1.1 Recommendations
    2. 7.2 Kenya
      1. 7.2.1 Recommendations
    3. 7.3 Ethiopia
      1. 7.3.1 Recommendations
    4. 7.4 South Sudan
Guide pratique du nouveau-né

7.2 Kenya

Neonatal mortality remains a key issue of public health concern in Kenya and currently stands at 20.5 per 1,000 live births[1]. In 2019, 39% of neonatal deaths were due to pre-term birth complications[2] and 26% due to intra-partum related events. Kenya continues to be among the top refugee hosting countries in Africa with over 500,000 refugees[3] and asylum seekers currently living in the country. Almost half (44%) of the refugees in Kenya reside in Dadaab in Eastern Kenya and 40% in Kakuma. In both camps and around the country, the population experiences cyclic humanitarian situations caused by conflict, harsh climatic conditions, population movements and disease outbreaks; and continue to record poor outcomes for newborns.

Health care services in Dadaab camps[4] are overseen by UNHCR and provided free-of-charge through a range of non-governmental organizations (NGO) partners that operate 16 health posts, four hospitals, and one stand-alone maternity centre, in addition to community outreach services. Providing health and other services in the camps is constrained for a number of reasons. Security issues, including kidnappings of humanitarian aid staff, improvised explosive devices, and attacks on refugee leaders and Kenyan police, have heightened security restrictions and made aid provision challenging.
In April 2019, UNICEF Kenya collaborated with the National and County Ministries of Health from Garissa and Wajir, to conduct an orientation workshop with key stakeholders such as UNHCR, Médecins Sans Frontières, International Rescue Committee, and Red Cross Kenya on implementing the recommendations of the Newborn Field Guide.

The workshop was attended by 30 representatives from local NGOs working as implementing partners, neonatologists and obstetricians representing county health offices, and professionals from WASHabbreviation, M&Eabbreviation, Gender and Nutrition sectors.

in addition to becoming sensitised to the needs of newborns in humanitarian settings, participants noted the need to include maternal and newborn health in national and sub-national emergency preparedness and response plans and the need to strengthen linkages across the various levels of care and the humanitarian-development sectors. Following the workshop, UNICEF has been working in Garissa to strengthen newborn health services provision at the community level, in line with the Newborn Field Guide recommendations, and is also currently setting up a learning hub for the community.

Additionally, the Newborn Field Guide, complemented by the KMC guidelines, were used by UNICEF Kenya to sensitise representatives from the Kenya Ministry of Health in the counties of Turkana (hosting the Kakuma refugee camp), West Pokot, Baringo and Samburu in August 2019. Participants in this sensitisation workshop included Chief Officers for Health, senior programme officers and other senior MOH representatives. The meeting was hosted by Baringo County in Kabarnet and it included a field visit to the newborn unit at Kabarnet County Referral Hospital.

As part of the session, participants from each of the counties were tasked to do a situational analysis in order to develop a comprehensive understanding of newborn health related needs, services and gaps in their counties. Counties acknowledged that in many of their facilities, care for small babies was still dependent on the use of incubators which were in short supply. The situational analyses also showed that all the newborn units in the 4 counties faced the challenge of inadequate staff to care for small babies and of the staff that was available, many lacked specialized skills to provide quality newborn care.

At the end of the workshop, participants committed to undertaking a few immediate steps such as rolling out KMCabbreviation to the sub-county hospitals and primary health care facilities, including neonatal data in quarterly review meeting and undertaking training of health care providers. There was also consensus for the need for long term planning and strengthening of multi-stakeholder coordination across all levels of care. The UNICEF field teams have been following up with counties on their progress.

7.2.1 Recommendations

There was consensus amongst participants on the following recommendations. These were consistent across Uganda, Kenya, and Ethiopia.

  • Strengthening community engagement to identify and address community bottlenecks
  • Strengthen linkages between refugee health facilities and host population facilities
  • Better use of data from the surveillance team ensures preparedness and effective response in time
  • Conducting training of managers, health professionals, community gate leaders and other stakeholders on newborn and patient friendly services
  • Improving logistical support and redistribution of commodities
  • Improving scientific evidence and innovation on models of care in fragile and humanitarian settings
  • Mainstream existing guidelines with the newborn health in humanitarian situations

Abréviations

  1. UNICEF. Neonatal Mortality. January 2023. ↩︎

  2. Healthy Newborn Network. Leading causes of neonatal deaths in Kenya. 2019. ↩︎

  3. UNHCR. Refugee Population Statistics Database, Kenya. 2022. ↩︎

  4. Gee, S., Vargas, J. & Foster, A.M. “The more children you have, the more praise you get from the community”: exploring the role of sociocultural context and perceptions of care on maternal and newborn health among Somali refugees in UNHCR supported camps in Kenya. Confl Health 13, 11 (2019). ↩︎