Health-care providers' knowledge and quality of neonatal care in the first 2 h of life in a district hospital on Pemba Island, Tanzania: a prospective cohort study

To assess the knowledge of health workers on neonatal management, describe neonatal care in the first 2 h of life, and health outcomes of neonates in Tanzania. A prospective cohort study was performed from January to April 2022 at a district hospital on Pemba Island, Tanzania. Women admitted in active labor, and their neonates were eligible for inclusion. Standardized observations in the first 2 h after birth, followed by a clinical examination, and interviews on days 7 and 28 were performed. Health workers were given multiple-choice questions on neonatal management. Immediate skin-to-skin care was performed in 23% of neonates and breastfeeding was initiated during the first hour of life in 46%. At 2 h of life, 10% had blood glucose <2.5 mmol/L (mean: 3.71, SD 1.1), 44.6% had hypothermia with temperature <36.5°C (mean: 36.5, SD 0.5), and 2% low saturation <90%. Health workers had on average 42% correct answers on "neonatal management". The neonatal mortality rate (NMR) corresponds to 23 per 1000 livebirths. Considerable challenges in neonatal care were identified, including low-cost, high-impact interventions such as skin-to-skin care and immediate breastfeeding. The NMR was above the Sustainable Development Goal target. Further research is needed to assess the impact of training on neonatal care and outcomes in this and similar settings.