{
  "abstract": "Why did you do this work? Defining a pragmatic and informative dataset is essential to guide service delivery. 1–3 The Nepal Neonatal and Emergency Paediatric Care Programme is a collaboration between RCPCH, Nepal Paediatric Society and UNICEF, working with local quality improvement champions in 12 government hospitals in Madhesh Pradesh. Programme and hospital staff identified the need to evaluate audit processes in view of data challenges in the low-resource setting.We aimed to identify the most relevant and feasible data indicators for monthly capture to evaluate service use and quality of care of paediatric systems within Programme hospitals.What did you do? This was a mixed-methods review with focus groups of Nepali hospital clinicians and a single-round survey of an expert advisory group of Nepali and UK paediatricians, nurses and Programme staff. The study was conducted ensuring representation from each of the 12 hospitals in Madhesh Pradesh and with data collection infrastructure established through Programme activities run by Nepali staff.Focus and expert groups acknowledged importance of key global paediatric indicators[1 but also the need to identify proxy or surrogate indicators due to data feasibility challenges. Challenges included frontline data collection issues (data recording accuracy, data loss due to patient flows in complex public-private patient intersections), multilateral organisations in the same environment (local and central government, charitable organisations, NGOs) and lack of digital infrastructure. Revised aims included gaining consensus on valid and feasible surrogate indicators.What did you find? Focus groups of Nepali stakeholders2–3 clinical representatives (doctors, nurses and paramedicals) from each of the 12 hospitals contributed to a focus group discussion reviewing key domains of measuring the quality of paediatric care in their hospitals. Themes emerging from the group discussions included: mapping and measuring the implementation of triage and volume of children assessed in each triage category; neonatal care including newborn health outcomes and newborn unit flow; referral pathways including patient flow and quality of handover.Expert surveyThe online survey received 19 responses (68% female, 37% Nepal-based) from Nepali paediatricians, nurses and RCPCH Global clinicians, advisors, management staff. The single round survey identified the following indicators across specified domains: patient flow (deaths, admissions, outpatient and emergency attendances, livebirths, stillbirths), patient care (triage, observations), morbidities (neonatal hypoglycaemia, hypothermia, sepsis), care (postnatal check, WASH facilities, newborn resuscitation). Figure 1 shows a summary of the single-round survey ranking neonatal morbidity indicators.What does it mean? Identifying optimal data indicators to be evaluated on a monthly basis needs to be balanced with the need to measure key outcomes and the feasibility of data collection. 3 domains have emerged through this international, multisector and multidisciplinary review process: patient flow, service availability and sample clinical care audits. The next phase will be a pilot data collection to evaluate the feasibility of selected data points planned for late 2024.References Muzigaba M, Chitashvili T, Choudhury A, et al. Global core indicators for measuring WHO’s paediatric quality-of-care standards in health facilities: development and expert consensus. BMC Health Serv Res. 2022;22:887.Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, Black RE, Dalmiya N, Duggan CP, Hofmeyr GJ, Kennedy SH, Klein N, Lawn JE, Shiffman J, Simon J, Temmerman M. UNICEF-WHO low birthweight estimates group. Small vulnerable newborns-big potential for impact. Lancet 2023 May 20;401(10389):1692–1706. doi: 10.1016/S0140-6736(23)00354-9.D’Souza R, Prakash B, Yadav NK, Ross O, Subedi K. Small vulnerable newborns in Nepal: the need for data. Lancet 2024 Feb 17;403(10427):614.Abstract 8074 Figure 1Results from a single round survey of the RCPCH Global Nepal working group evaluating key indicators for measures of neonatal morbidity diagnoses. Survey response rating options: 1=not important, 2=important but not critical, 3=criticalAcknowledgements The NNEPCP would like to thank all hospital champions, global links mentors and management staff who have supported this project.",
  "authors": [
    {
      "affiliations": [
        "University College London"
      ],
      "name": "Rashmi Sarah D’Souza"
    },
    {
      "affiliations": [
        "Nepal Neonatal and Emergency Paediatric Care Programme, Madhesh Pradesh, Nepal"
      ],
      "name": "Nirala Kumari Yadav"
    },
    {
      "affiliations": [
        "Nepal Neonatal and Emergency Paediatric Care Programme, Madhesh Pradesh, Nepal"
      ],
      "name": "Baliram Mishra"
    },
    {
      "affiliations": [
        "Nepal Paediatric Society, Nepal"
      ],
      "name": "Sangita Shakya"
    },
    {
      "affiliations": [
        "Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal"
      ],
      "name": "Kalpana Subedi"
    },
    {
      "affiliations": [
        "Nepal Paediatric Society, Nepal"
      ],
      "name": "Jamun Singh"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Hannah Crosby-Wood"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Sarah Humphreys"
    },
    {
      "affiliations": [
        "Nepal Neonatal and Emergency Paediatric Care Programme, Madhesh Pradesh, Nepal"
      ],
      "name": "Bindu Kumar Jha"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Katie Wood"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Misbah Bhamani"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Bhanu Williams"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Mithilesh Lal"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Sebastian Taylor"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Simon Struthers"
    },
    {
      "affiliations": [
        "Royal College of Paediatrics and Child Health, UK"
      ],
      "name": "Oliver Ross"
    }
  ],
  "title": "8074 Framing an essential dataset for newborn and paediatric care: a mixed-methods RCPCH global review of data processes within the Nepal programme",
  "uid": "f2e98b96-c67f-54a1-8154-94f5160e3355"
}