Kinshella Mai-Lei Woo, Salimu Sangwani, Hiwa Tamanda, Banda Mwai, Vidler Marianne, Newberry Laura, Dube Queen, Molyneux Elizabeth M, Goldfarb David M, Kawaza Kondwani, Nyondo-Mipando Alinane Linda
Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.
Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Implement Sci Commun. 2020 Nov 4;1(1):100. doi: 10.1186/s43058-020-00092-8.
While Malawi has achieved success in reducing overall under-five mortality, reduction of neonatal mortality remains a persistent challenge. There has, therefore, been a push to strengthen the capacity for quality newborn care at district hospitals through the implementation of innovative neonatal technologies such as bubble continuous positive airway pressure (CPAP). This study investigates tertiary- versus secondary-level hospital differences in capacities for bubble CPAP use and implications for implementation policies.
A secondary analysis of interviews was conducted with 46 health workers at one tertiary hospital and three secondary hospitals in rural Southern Malawi. Grounded theory was utilized to explore the emerging themes according to health worker cadres (nurse, clinician, district health management) and facility level (tertiary- and secondary-level facilities), which were managed using NVivo 12 (QSR International, Melbourne, Australia).
We identified frequent CPAP use and the availability of neonatal nurses, physicians, and reliable electricity as facilitators for CPAP use at the tertiary hospital. Barriers at the tertiary hospital included initiation eligibility disagreements between clinicians and nurses and insufficient availability of the CPAP machines. At secondary-level hospitals, the use was supported by decision-making and initiation by nurses, involving caretakers to assist in monitoring and reliable availability of CPAP machines. Bubble CPAP was hindered by unreliable electricity, staffing shortages and rotation policies, and poor systems of accountability.
While this study looked at the implementation of bubble CPAP in Malawi, the findings may be applicable for scaling up other novel neonatal technologies in low-resource settings. Implementation policies must consider staffing and management structures at different health services levels for effective scale-up.
虽然马拉维在降低五岁以下儿童总体死亡率方面取得了成功，但降低新生儿死亡率仍然是一项持续存在的挑战。因此，通过实施诸如气泡持续气道正压通气（CPAP）等创新新生儿技术，推动加强地区医院提供高质量新生儿护理的能力。本研究调查了三级医院和二级医院在使用气泡CPAP能力方面的差异以及对实施政策的影响。
对马拉维南部农村地区一家三级医院和三家二级医院的46名卫生工作者进行的访谈进行了二次分析。运用扎根理论，根据卫生工作者类别（护士、临床医生、地区卫生管理人员）和机构级别（三级和二级机构）探索新出现的主题，这些主题使用NVivo 12（澳大利亚墨尔本QSR国际公司）进行管理。
我们确定在三级医院频繁使用CPAP以及有新生儿护士、医生和可靠电力供应是使用CPAP的促进因素。三级医院的障碍包括临床医生和护士之间在启动资格上的分歧以及CPAP机器供应不足。在二级医院，使用得到护士的决策和启动支持，让护理人员协助监测以及CPAP机器可靠供应。气泡CPAP受到电力供应不可靠、人员短缺和轮班政策以及问责制度不完善的阻碍。
虽然本研究着眼于马拉维气泡CPAP的实施情况，但研究结果可能适用于在资源匮乏地区扩大其他新型新生儿技术的应用。实施政策必须考虑不同卫生服务层面的人员配备和管理结构，以实现有效推广。
