Shayo Fredrick Salvatory, Kessy Anna Tengia, Amour Maryam
Department of Developmental Studies, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania.
Department of Community Health, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania.
BMC Health Serv Res. 2025 Mar 14;25(1):381. doi: 10.1186/s12913-025-12517-y.
This case study was conducted at Amana Regional Referral Hospital, a referral hospital of Ilala District in Dar es Salaam Region, Tanzania. The aim is to assess the adherence of healthcare providers to guidelines when providing health services to neonates with respiratory distress and how supportive the health system is in limited resource settings.
This is a case study that used a qualitative approach to data collection and analysis. A total of 16 participants participated in this study, of which the sample size was reached by the principle of information saturation in the field. The study population was healthcare providers (pediatricians, general medical doctors, and nurses) working in the neonatal ward who were selected purposively depending on their experience in the neonatal ward. In-depth interviews (IDI) and an observation checklist were used for data collection from key informants, and content analysis was used to analyze the data.
The findings revealed that healthcare providers had partially adhered to guidelines in managing neonates with respiratory distress. The Silverman-Anderson Severity (SAS) score tool is recommended for decision-making in prioritizing neonates with respiratory distress to Continuous Positive Airway Pressure (CPAP) treatment in limited-resource health settings with low laboratory technology. Healthcare providers know the importance of using the SAS score tool, but this study shows partial adherence to the use of it. Understaffing, inadequate training, heavy workloads, and lack of motivation emerged as significant deterrents to adherence which are within the health system, and they negatively impact healthcare provider's adherence. These challenges hindered proper monitoring, documentation, and decision-making processes for CPAP initiation and monitoring.
Partial adherence to guidelines for managing neonates with respiratory distress in the context of consistent use of the SAS score tool by healthcare providers was impacted by challenges like understaffing, heavy workloads, and low motivation. Improving staffing, providing comprehensive training, and ensuring adequate equipment are recommended to enhance guideline adherence and improve neonatal care in resource-limited settings.
本案例研究在坦桑尼亚达累斯萨拉姆地区伊拉拉区的转诊医院阿马纳地区转诊医院开展。目的是评估医疗服务提供者在为呼吸窘迫新生儿提供医疗服务时对指南的遵循情况，以及卫生系统在资源有限环境中的支持程度。
这是一项采用定性方法进行数据收集和分析的案例研究。共有16名参与者参与了本研究，样本量通过实地信息饱和原则确定。研究人群是在新生儿病房工作的医疗服务提供者（儿科医生、普通医生和护士），根据他们在新生儿病房的经验有目的地进行选择。通过深入访谈（IDI）和观察清单从关键信息提供者处收集数据，并采用内容分析法对数据进行分析。
研究结果显示，医疗服务提供者在管理呼吸窘迫新生儿时部分遵循了指南。在实验室技术水平较低的资源有限的卫生环境中，建议使用西尔弗曼 - 安德森严重程度（SAS）评分工具来决定对呼吸窘迫新生儿进行持续气道正压通气（CPAP）治疗的优先级。医疗服务提供者知道使用SAS评分工具的重要性，但本研究表明在使用该工具方面存在部分遵循的情况。人员不足、培训不足、工作量大以及缺乏动力成为遵循指南的重大阻碍，这些都存在于卫生系统内部，并且对医疗服务提供者的遵循情况产生负面影响。这些挑战阻碍了CPAP启动和监测的适当监测、记录及决策过程。
在医疗服务提供者持续使用SAS评分工具的情况下，对呼吸窘迫新生儿管理指南的部分遵循受到人员不足、工作量大以及动力不足等挑战的影响。建议增加人员配备、提供全面培训并确保设备充足，以提高在资源有限环境中的指南遵循情况并改善新生儿护理。
