Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

Abstract

Background: Bubble continuous positive airway pressure (CPAP) has been shown to be effective in supporting breathing in newborns with respiratory distress. The factors that influence implementation in resource-constrained settings remain unclear. The objective of this review is to evaluate the barriers and facilitators of CPAP implementation for newborn care at sub-Saharan African health facilities and how different facility levels and types of bubble CPAP systems may impact utilization. Methods: A systematic search (database inception to July 2019) was performed on MEDLINE Ovid, EMBASE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), the WHO Regional Database for Africa, African Index Medicus (AIM), African Journals Online, grey literature and the references of relevant articles. Studies that met the inclusion criteria (primary research, bubble CPAP implementation with neonates ≤ 28 days old at a health facility in sub-Saharan Africa) were included in the review and assessed with National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) quality assessment tools. The review protocol was published to PROSPERO (CRD42018116082). Results: Seventeen studies were included in the review. Reliable availability of equipment, effectively informing and engaging caregivers and staffing shortages were frequently mentioned barriers to the implementation of bubble CPAP. Understaffed neonatal units and high turnover of nurses and doctors compromised effective training. Provider-to-provider clinical mentorship models as well as affordability and cost-effectiveness of innovative bubble CPAP systems were identified as frequently mentioned facilitators of implementation. Conclusions: With a strong recommendation by the World Health Organization for its use with premature infants with respiratory distress, it is important to understand the barriers and facilitators that can inform the implementation of bubble CPAP. More research is needed into health system factors that can support or impede the use of this potentially promising intervention.

Barriers and facilitators of facility-based kangaroo mother care in sub-Saharan Africa: a systematic review

“…This reduces capacities for sustainable implementation of KMC as well as other neonatal innovations. Similar barriers of staffing rotation policies, understaffed neonatal units and inadequate support provided to families can be seen with the implementation of bubble continuous positive airway pressure in sSA, an intervention to support care of preterm and LBWI with respiratory distress [ 40 ].…”

Respiratory distress syndrome in preterm neonates in the era of precision medicine: A modern critical care-based approach

“…61 Conversely, bubble CPAP generated by water valve has a very low cost and ease of use and this may facilitate its diffusion also in low income settings. 62 We do not know the best pressure level to be chosen in the early phase of RDS and this remains a major problem. However, relatively high CPAP levels (7/9 cmH 2 O) have been able to reduce extubation failure in preterm infants 63 and they are often used at least in some NICU protocols.…”

Skewed logit model for analyzing correlated infant morbidity data

“…This study is focused on BV related morbidities, since this remains a major point of concern globally and particularly in Africa, where the majority of BV cases are recorded [ 17 – 19 ]. Child morbidity and mortality as a consequence of BV in conjunction with human immunodeficiency virus (HIV) has been a significant hindrance to meeting goal three of the United Nations Sustainable Development Goals (UN-SDGs) on Good Health and Well-being [ 20 ], which aims to end preventable deaths of newborns and children under 5 years of age.…”