1. Cathy Rehfus-Wilsek, MBA, MD
1-June-2015
Quality Improvement (QI) in Percentage of
Neonatal Visits at Majengo Health Center
Moshi Tanzania

2. Lecture Objectives
 Show how simple techniques of neonatal assessments
improves percentage of weekly visits
 Show how maternal education improves number of
weekly visits

3. Why Teach Neonatal Assessment
Techniques?
 Provides better care for neonates
 Allows labor/neonatal staff to detect infant
distress early
 Early detection means early treatment and
decreased morbidity
 Continued monitoring of neonates helps reduce
infant mortality rates
 An increase in neonatal care and decrease in
morbidity leads to a cost saving of healthcare
resources

4. Karibu Duniani, 10 Easy Steps for
an Initial Neonatal Assessment
General Survey of the infant: Awake/Alert/Active or Asleep
1. Vital signs and auscultation of heart and lungs before the neonate begins to cry
2. HEENT (Head, Ears, Eyes, Nose, Throat/Mouth)
3. Rooting and Sucking reflexes
4. Neck Tone and Moro/Startle reflex
5. Chest
6. Abdomen
7. Urogenital including Urine/Stool
8. Skin
9. Extremities (Arms and Legs)
10. Back and Spine

5. Karibu Duniani, 10 Easy Steps for an
Initial Neonatal Assessment
Broken down into easy terms for Majengo Staff
General Survey of the infant: Awake/Alert/Active or Asleep
1) Vital signs and auscultation of heart and lungs before the neonate begins to cry
INFANT DATA (Circle one where necessary)
Male/mwaname or Female/kwanamke Weigh at birth: kg Length at birth: cm
Head Circumference/mzunguka wa kuchwa: cm Chest Circumference/mzunguka wa kifua: cm
VITAL SIGNS (Circle one where necessary)
Temperature (axillary): °C Heart Rate: Heart Rhythm: Regular or Slow or Fast Heart Murmurs: Yes or No
Respiration Rate: Lungs: Clear or Crackles Bilateral: Yes or No Respiratory Effort: Minimal or Moderate or Difficult
Appearance/Activity: Awake and Alert and Active or Asleep Infant Posture: Flexed or Extended Arms Flexed or Extended Legs:
Range of Motion: Full or Limited: Quality of Cry: Healthy or None or High Pitch - If High Pitch, is infant in distress? Yes or No

6. Karibu Duniani, 10 Easy Steps for an
Initial Neonatal Assessment
Broken down into easy terms for Majengo Staff
2) HEENT (Head, Ears, Eyes, Nose, Throat/Mouth)
HEAD ASSESSMENT (Circle one where necessary)
HAIR:
Color: Amount: Full or Sparse Distribution: Full or Scattered
HEAD:
Fontanels: Anterior: Open or Depressed or Bulging Posterior: Open or Depressed or Bulging Shape: CVD or Round
Sutures: Open or Overriding Caput Succedaneum (Crosses Midline): Yes or No Cephalhematoma: Yes or No
FACE:
Symmetrical: Yes or No Milia: Yes or No Mandible Intact: Yes or No Abnormalities:
EYES:
Symmetrical: Yes or No Shape: Round or Oval Eyes: Clear or Jaundice Discharge: Yes or No Eyebrows Intact: Yes or No
Nystagmus (rhythmic ocular oscillation of the eyes): Yes or No Abnormalities:
EARS:
Symmetrical: Yes or No Aligned w/eyes: Yes or No Shape: WNL or abnormal Hearing: Yes or No Discharge: Yes or No
NOSE:
Symmetrical: Yes or No Midline: Yes or No Shape: WNL or abnormal Patent Nares: Yes or No Bilateral: Yes or No
MOUTH:
Symmetrical: Yes or No Midline: Yes or No Gums: Pink or Blue Epstein's pearls: Yes or No Clefts: Yes or No

7. Karibu Duniani, 10 Easy Steps for an
Initial Neonatal Assessment
Broken down into easy terms for Majengo Staff
3) Rooting and Sucking reflexes & 4) Neck Tone and Moro/Startle reflex
REFLEXES
Rooting/Sucking: Yes or No Moro's/(Startle): Yes or No Grasp/Palmar: Yes or No Babinski's: Yes or No
5) Chest
CHEST ASSESSMENT (Circle one where necessary)
Symmetrical: Yes or No Clavicles Intact: Yes or No Breast Tissue: Flat or Full Supernumerary Nipples: Yes or No
6) Abdomen
ABDOMINAL ASSESSMENT (Circle one where necessary)
Symmetrical: Yes or No Bowel Sounds: Yes or No Hernias: Yes or No Type: Umbilical Cord: 3 vessels or infection
7) Urogenital
UROGENITALIA ASSESSMENT (Circle one where necessary)
FEMALE
Labia Majora: Yes or No Minora: Yes or No Clitoris: Yes or No Urethral Opening: Yes or No Vaginal Discharge: Yes or No
MALE
Urethral Opening: Normal or Epispadias or Hypospadias Scrotum: Yes or No Testis Descended Bilateral: Yes or No
Urination: Yes or No Stool: Yes or No (Meconium): Yes or No Patent Anus: Yes or No Comments:

8. Karibu Duniani, 10 Easy Steps for an
Initial Neonatal Assessment
Broken down into easy terms for Majengo Staff
8) Skin
SKIN (Circle one where necessary)
Body Color: Pink or Blue Vernix/NTA mipako: Yes or No Location: Skin Texture: Soft/Smooth or Tight/Wrinkled
Birth Marks: Yes or No Location: Mottling (uneven spots): Yes or No Desquamation (peeling skin): Yes or No
Mongolian Spots: Yes or No Location: Other Abrasions/Bruising/Lacerations: Yes or No Location:
9) Extremities (Arms/Legs)
EXTREMITIES/SKELETAL ASSESSMENT (Circle one where necessary)
ARMS/ LEGS
Number of Fingers: Number of Toes: Acrocyanosis: Yes or No Color: Pink or Blue Hip Dysplasia: Yes or No
10) Spine
VETERBRAL SYSTEM
Spine Intact: Yes or No Shoulders Intact: Yes or No Scapulae Intact: Yes or No
Pilonidal Dimples (buttocks cysts): Yes or No Comments:

9. Karibu Duniani, 10 Easy Steps for an
Initial Neonatal Assessment
Broken down into easy terms for Majengo Staff
ASSESSMENT AND PLAN
Discharge Date: Instructions: Educate mother on proper care and
feeding of infant: keep baby clean and dry, especially the umbilical area, feed every 2-3 hours 15 minutes per breast. Watch for
signs and symptoms of infection (high fever) or jaundice (yellow eyes and skin). Return to the clinic with infant every week for
one month.
Additional information:
Medications for mtoto: TCL Eye Ointment apply small amount to each eye TID x5/days
Medications for mama: Ferrous Sulfate/Folate 1 tab PO qD x30/days
B Complex Vitamins 1 tab PO qD x30/days
Paracetamol 500 mg tab PO q 4-6 h PRN for pain
Provider Name (Print): Signature: Date:

10. Numbers Tell the Story
26%
23%
32%
17%
29%
43%
38%
12%
17%
7%
28%
19%
27%
57%
8%
5%
16%
8%
6%
13%
36%
5% 4% 4%
11%
3%
11%
58%
51%
48%
59%
64%
57%
94%
Mean increase
47%
Nov Dec Jan Feb Mar April Increase
Percentage of Weekly Visits of Neonates Born Between 1-Nov-14 and 1-
Apr-15
Week one visit % Week two visit % Week Tthree visit % Week four visit % Actual Visits vs Total Births %
Previous to the introduction of Karibu Duniani, the 10 East Steps for an Initial Neonatal
Assessment, in March of 2015, the average of all weekly visits increased with an overall
increase of 47%.

11. Numbers Tell the Story
Previous to the introduction of Karibu Duniani, the 10 East Steps for an Initial Neonatal
Assessment, in March of 2015, the average of total weekly visits increased with an
overall increase of 70%.
16%
34% 34%
19%
14%
19%
14%
4%
21%
2%
30%
19% 17%
79%
3%
9%
4% 6%
30% 31%
91%
1% 4% 2%
8%
13%
30%
97%
24%
68%
42%
63%
75%
97%
Mean increase
70%
Nov Dec Jan Feb Mar April Increase
Total Number of Weekly Visits of Neonatal Born Between 1-Nov-14 and 1-
Apr-15Only one week visit Only two weeks visits Only three weeks visit All four week visits Actual Visits vs Total Births %