Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
College of Medicine, IMCHA Project, Blantyre, Malawi.
PLoS One. 2020 Feb 13;15(2):e0228915. doi: 10.1371/journal.pone.0228915. eCollection 2020.
Preterm birth complications are the leading cause of neonatal deaths. Malawi has high rates of preterm birth, with 18.1 preterm births per 100 live births. More than 50% of preterm neonates develop respiratory distress which if left untreated, can lead to respiratory failure and death. Term and preterm neonates with respiratory distress can often be effectively managed with Continuous Positive Airway Pressure (CPAP) and this is considered an essential intervention for the management of preterm neonates by the World Health Organization. Bubble CPAP may represent a safe and cost-effective method for delivering CPAP in low-income settings.
The study explored the factors that influence the implementation of bubble CPAP among health care professionals in secondary and tertiary hospitals in Malawi.
This was a qualitative study conducted in three district hospitals and a tertiary hospital in southern Malawi. We conducted 46 in-depth interviews with nurses, clinicians and clinical supervisors, from June to August 2018. All data were digitally recorded, transcribed verbatim and thematically analyzed.
Factors that influenced implementation of bubble CPAP occurred in an interconnected manner and included: inadequate healthcare provider training in preparation for use, rigid division of roles and responsibilities among providers, lack of effective communication among providers and between providers and newborn's caregivers, human resource constraints, and inadequate equipment and infrastructure.
There are provider, caregiver and health system level factors that influence the implementation of bubble CPAP among neonates in Malawian health facilities. Ensuring adequate staffing in the nurseries, combined with ongoing training for providers, team cohesion, improved communication with caregivers, and improved hospital infrastructure would ensure optimal utilization of bubble CPAP and avoid inadvertent harm from inappropriate use.
早产并发症是新生儿死亡的主要原因。马拉维的早产率很高，每 100 例活产中就有 18.1 例早产。超过 50%的早产儿出现呼吸窘迫，如果不治疗，可能导致呼吸衰竭和死亡。有呼吸窘迫的足月和早产儿通常可以通过持续气道正压通气（CPAP）进行有效治疗，世界卫生组织认为 CPAP 是治疗早产儿的基本干预措施。气泡 CPAP 可能是在低收入环境中提供 CPAP 的一种安全且具有成本效益的方法。
本研究探讨了马拉维二级和三级医院的医护人员在实施气泡 CPAP 时所面临的影响因素。
这是一项在马拉维南部的 3 家地区医院和 1 家三级医院开展的定性研究。我们于 2018 年 6 月至 8 月对护士、临床医生和临床主管进行了 46 次深入访谈。所有数据均以数字形式记录、逐字转录并进行主题分析。
影响气泡 CPAP 实施的因素以相互关联的方式发生，包括：医护人员在使用前的培训不足、提供者之间的角色和责任划分僵化、提供者之间以及提供者与新生儿护理人员之间缺乏有效沟通、人力资源不足以及设备和基础设施不足。
马拉维医疗机构中存在影响气泡 CPAP 在新生儿中实施的医护人员、护理人员和卫生系统层面的因素。确保托儿所有足够的人员配备，同时对提供者进行持续培训、增强团队凝聚力、改善与护理人员的沟通，并改善医院基础设施，将确保气泡 CPAP 的最佳利用，并避免因不当使用而造成意外伤害。
