The Golden Hour - Implementing and evaluating a package of interventions to improve newborn care in the first hour of life in a public sector hospital in Zimbabwe.

Reducing neonatal mortality remains a global priority, yet progress has stalled in many low-resource settings. Low-cost interventions such as delayed cord clamping (DCC) and early skin to skin care (ESSC) are known to reduce neonatal morbidity and mortality but implementation remains inconsistent. Prior to project initiation, Sally Mugabe Central Hospital, Zimbabwe's busiest tertiary maternity unit had no documented DCC or ESSC conducted with practice limited by staffing pressures and infrastructural challenges. We aimed to implement a context-specific Golden Hour care bundle to improve newborn care during the first hour after birth. Using quality improvement (QI) methodology we designed interventions alongside maternity staff, including multidisciplinary training, embedded clinical support, regular feedback, leadership engagement and equipment provision. Real-time progress was tracked using the Neotree digital data tool over 12 months (November 2024-October 2025). The primary outcome was documented DCC and ESSC in eligible infants. An analysis of neonatal mortality among a subset of admitted inborn infants was also carried out. A total of 207 healthcare workers and 87 student midwives received formal training. Over 12 months, 15,292 eligible infants (81.1%) received DCC and 14,351 (76.1%) received ESSC with sustained implementation between 82-91% (DCC) and 72-85% (ESSC) for the final seven months of the project. Targeted PDSA cycles increased uptake in low birthweight infants and babies born by caesarean section. Logistic regression analysis of infants admitted to the neonatal unit demonstrated a trend to reduction in crude mortality for eligible infants receiving both interventions but this did not reach statistical significance. A multifaceted, context-specific QI programme successfully embedded evidence-based Golden Hour practices in a high-volume, resource-constrained maternity unit. Combining education, equipment, clinical support and continuous data feedback achieved sustained change in practice and a trend towards improved survival.