PC1042: Improving Delayed Cord Clamping in Addis Ababa, Ethiopia: A Virtual Partnership Experience Between the American Academy of Pediatrics and the Ethiopian Pediatric Society

Purpose/Objectives: Delayed cord clamping (DCC) has been shown to improve newborn outcomes by increasing the volume of blood transferred from the placenta to the infant and by allowing time for physiologic transition. Recommendations dictate DCC for 1-3 minutes after birth in vigorous infants. Despite this guidance, the practice of DCC has not yet been adopted in many resource-constrained settings. In 2020 the Ethiopian Pediatric Society and the American Academy of Pediatrics initiated a quality improvement (QI) partnership aimed at improving evidence-based care practices in select birthing facilities in Addis Ababa, Ethiopia, with an initial focus on DCC. The aims of this QI partnership were to 1) examine the impact of a QI program focused on DCC across eight birthing facilities in Ethiopia and 2) assess the feasibility and acceptability of engaging United States neonatal physician teams to serve as QI advisors for a group of Ethiopian midwives.

Design/Methods: Eight facilities were selected by the Ethiopian Pediatric Society and a midwife was identified at each site to serve as the site leader and QI coach. Site leaders were paired with a US team, consisting of a neonatal physician faculty member and fellow. Each site set an aim that was Specific, Measurable, Achievable, Realistic and Timebound (SMART) for local improvement in DCC. Monthly virtual meetings were held to focus on QI training, peer learning, and site-specific progress and challenges. DCC data was recorded prospectively through direct observation, utilizing the Liveborn Mobile Application by Laerdal Research. Teams tracked progress toward their SMART aim using run charts. Post-program surveys of the Ethiopian midwives assessed satisfaction with the virtual, collaborative format and the impact of the US partnership.

Results: The timing of DCC in 3500 deliveries were observed from March 2021 to January 2022. All eight sites met their SMART aim targets, which ranged from rates of 50% to 90% for DCC. Baseline rates ranged from 7% to 72%, with 6 of the 8 sites having initial DCC rates at or below 50%. By January 2022 six sites had DCC rates above 90% with all sites having sustained rates above 50%. A combined analysis of all sites included over 3500 observed deliveries and an end-of-project DCC rate above 90%.(Figure 1) All participating Ethiopian coaches found benefit in the program and plan to continue QI work.(Figure 2)

Conclusion/Discussion: A quality improvement initiative to improve DCC rates at eight birthing centers in Addis Ababa significantly increased the rate of this evidence-based practice. Midwife leaders from the clinical sites found benefit in working collaboratively with Ethiopian peers and through partnership with US neonatal physician teams. Further investigation into the critical aspects of this successful virtual model of a multidisciplinary international QI collaborative are warranted given the opportunities for improvement, scalability, and impact.