Introduction:

In January 2007, the LUTH Management led by Professor Akin Osibogun invited Hippolite Amadi of Imperial College London, United Kingdom to provide professional advice after inspection and assessment of the available neonatal systems in the hospital. This exercise confirmed the poor state of the neonatal facilities and especially the non-availability of any functional incubators in the hospital. The standard of neonatal care was not at its best. Long period of absence of properly functioning incubators might have affected the level of experience required for effective neonatal incubator intervention. The hospital was, however able to preserve the remains of old and obsolete incubators in storage rooms and some in the wards.

The Management needed to do a lot to put practice on acceptable track but it was necessary that this started with the provision of thermoneutral systems. This led to LUTH’s initiation of the popularly known ‘Incubator Project’ for which Prof Amadi, by implication, was appointed a visiting consultant from January 2007.

RIT Applied:

It might have been financially very difficult for the Management to start reequipping the three sections of the newborn wards as a sensible take-off capacity could not be any less than 10 units of functional incubators. Standard incubators during this period were priced in excess of ₦3 million naira each in Nigeria. Recycled incubator technology (RIT) was launched in Nigeria in 2003, scholarly reviewed and published by the Annals of Tropical Paediatrics – International Child Health in 2007. This was a cheaper equivalent alternative that was assessed at less than 20% of the cost of modern incubators as long as there were available old or dysfunctional incubators for application. Management commissioned the operating organization, Polchazum Engineering Limited (PEL) to apply the RIT technique for the possible reactivation of some of the old systems. Thus, the first ten incubators were reintroduced into service at LUTH by the first week of February 2007 (Figure 1). Fig 1

Capacity Expansion:

With the success of the initial ten systems, Management strengthened its ‘commitment of understanding’ for a reasonable collaboration with PEL to utilize the hospital’s available old-incubators to attempt to provide adequate number of functional incubators in the three sections of our neonatal nursing, i.e. NNU, Wards D1 and E4. A mandatory 6-monthly maintenance servicing of all recovered systems was initiated and meticulously implemented all through the past 7 years till date, albeit at a fixed cost that was never upwardly reviewed all through the period. This failure-preventive audit culture (FAC) ensured the sustainability of acquired incubator capacity whilst more systems were being recycled, up to the present capacity of 27 recycled incubators. Our Incubator-project also attracted external donations from organizations to the tune of 11 other systems, making a total of 38 incubators. A total of 8 units of neonatal Resuscitaires were also acquired, making a grand total of 46 functional thermoneutral systems. This is the largest capacity anywhere in West Africa as at January 2014.

Other Charitable donations:

The project attracted donations of other useful items at various times during the inclusive years from individuals and organizations that were impressed by Prof Amadi’s medical outreaches to Nigeria. Some of these items included baby weighing scales, neonatal apnoea monitors and digital timers. Full elective course works on Paediatrics Incubation Technique were conducted at various times all through the years with average of 25 participants per stream attending. The various streams of the course (comprising a series of 5 lectures) had participants from the nursing and clinical divides. The costs of the courses were always funded by the United Kingdom supporters of Dr Amadi’s work which included the Hornchurch Baptist Church of Essex, England; so LUTH did not have to spend any money for all the staff that passed through the courses all through the years under review.

Comparative outcome:

Two international journal articles have so far been published in nation-wide studies involving this LUTH project. On a general sense, the re-invigorated nursing/clinical enthusiasm of our hard working staff and the constant availability of functional systems led to the overall improvement on indices of outcome. Figure 2 shows the yearly average of patient population as classified. The number of incubator-dependent-neonates (IDN) seeking intervention and the number of these saved are very crucial indicators that reflect societal impact. Figure 2.

(Yearly averages of classified neonates at NNU before start of project (pre-RIT) compared to averages at NNU and D1 as impacted by the project (post-RIT).

Figure 3 shows the fractional changes in the indicators when the pre-RIT situations at the NNU were fixed at unity. This revealed that total neonatal influx went up by more than 50%; IDNs seeking intervention went up by nearly 150% while over 100% extra IDNs were being saved as compared to the pre-RIT years.

This programme has made great impact in our confidence to handle challenging neonatal cases. This includes amongst others our highly improved success rate for simultaneous multiple-births, including quintuplets, which we have recently handled (Figure 4).