Collaborative Improvement of Newborn Care Focused on Screening for Microcephaly in the Context of Zika in Selected Countries of Latin America and the Caribbean

During the extension period (2017-2020) of the United States Agency for International Development (USAID) Applying Science to Strengthen and Improve Systems (ASSIST) Project, as part of the USAID response to the Zika virus epidemic in Latin America and the Caribbean (LAC), the USAID ASSIST Project applied continuous quality improvement (QI) and collaborative learning methods to strengthen prenatal care, newborn care, and care and support for children affected by the Zika virus during their mother’s pregnancy.

The USAID ASSIST Project’s Zika care improvement work was implemented in two phases, beginning in 2017. In the first phase, health facilities in the Dominican Republic, El Salvador, Guatemala, Honduras, and Nicaragua participated; in the second phase, activities in the original countries were expanded to new facilities and new Zika improvement programs were launched in Ecuador, Paraguay, and Peru. This report is focused on the newborn care improvement work in the Zika response activities of the project in these eight Latin American countries; in addition, ASSIST also supported Zika care improvement activities in five countries of the English-speaking Caribbean but without an explicit focus on newborn screening for microcephaly.

The Newborn Care Collaborative in the context of Zika engaged 222 QI teams in the same number of health facilities in the eight assisted countries in the LAC region. These teams sought to improve diagnosis and initial care for Congenital Syndrome associated with Zika virus (CSaZ) in newborns through pursuit of two improvement objectives: 1) increase the screening for microcephaly in newborns through correct measurement, documentation, interpretation, and classification of head circumference in all newborns; and 2) increase the referral for clinical follow-up of newborns detected with microcephaly or other anomaly associated with CSaZ.

To measure results and the effectiveness of improvement interventions, two indicators were tracked that were linked to these improvement objectives: 1) percentage of newborns correctly screened for microcephaly; and 2) number of newborns detected with microcephaly/CSaZ who were referred for clinical follow-up.

This document synthesizes the learning from improvement teams in the participating facilities in the LAC region, highlighting the interventions that teams found to be effective in improving indicator performance. The specific objectives of this knowledge synthesis are to: a) describe the phases of the regional Newborn Care Collaborative, the activities included in each phase, and the actors involved; b) present the results and describe the best practices (effective change ideas) that QI teams implemented to improve performance; c) identify barriers and common challenges that QI teams faced; and d) draw out the lessons learned and recommendations for future work.


USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project/URC
ASSIST publication: 
ASSIST publication
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