Missed opportunity for nasal continuous positive airway pressure in preterm neonates admitted at a tertiary-level hospital newborn unit in Kenya: a mixed method study.

BACKGROUND

Respiratory Distress Syndrome (RDS) is the most common complication of preterm neonates. It remains one of the major public health concerns that contribute to neonatal mortality and morbidity, especially in Africa, where 80% of neonatal mortality is estimated to be caused by preterm complications. Nasal Continuous Positive Airway Pressure (NCPAP) ventilation is the preferred mode of RDS treatment. However, NCPAP is not easily accessible to every preterm neonate in low- and middle-income countries, and this is the case in Kenya.

OBJECTIVES

To determine the proportion of preterm neonates admitted to the newborn unit (NBU) at Kenyatta National Hospital (KNH), a tertiary referral hospital in Kenya, with a missed opportunity for NCPAP and to determine the barriers and facilitators of NCPAP utilisation.

DESIGN AND SETTING

We conducted a hospital-based cross-sectional study that employed interactive explanatory concurrent mixed methods. The quantitative approach determined the proportion of missed opportunities for NCPAP in preterm neonates admitted to the KNH newborn unit, while the qualitative approach explored the barriers and facilitators of NCPAP utilisation.

PARTICIPANTS

Preterm neonates of gestation less than 37 weeks in the first 48 hours of life who met the criteria for NCPAP. The key informants were mainly different staff cadres from the newborn unit, a procurement officer and a biomedical engineer.

PRIMARY AND SECONDARY OUTCOME MEASURES

The proportion of preterm infants admitted to the newborn unit with a missed opportunity for NCPAP, and the barriers and facilitators of NCPAP utilisation.

RESULTS

167 preterm neonates were reviewed from July to November 2021 and analysed of whom 33.5% (95% CI 26.8% to 41.0%) missed the opportunity to receive NCPAP. 20 key informants were interviewed from September to October 2021. Facilitators of NCPAP use reported were (1) training of health workers, (2) availability of NCPAP machines, (3) KNH being a national and tertiary referral hospital able to receive neonates referred with RDS, (4) global evidence that NCPAP use is beneficial and (5) technology development. Barriers to NCPAP use were mainly (1) inadequate number of NCPAP machines, (2) inadequate training and mentorship, (3) inadequate and inappropriate size of NCPAP consumables, (4) staff shortage, (5) long servicing turnaround time, (6) long cleaning turnaround time, (7) infrastructure challenges and (8) insufficient utilities.

CONCLUSION

The missed opportunity for NCPAP in preterm neonates in Kenya is high. Barriers to NCPAP are related to medical products and technologies, health workforce-related challenges and service delivery. We recommend the provision of more NCPAP machines including supporting infrastructure and appropriate consumables, human resource support, frequent training and mentorship on NCPAP use.