Implementing bubble continuous positive airway pressure (bCPAP) in a lower middle-income country: a Nigerian experience

Abstract

Bubble CPAP (bCPAP) is used for respiratory distress (RD) in neonates. The leading causes of neonatal mortality can lead to severe RD. Many neonatal deaths are preventable using evidence-based interventions like bCPAP as part of a comprehensive approach. The study aimed to assess the implementation of a multi-center, comprehensive hospital-based bCPAP program in a low-middle-income country using a low-cost bCPAP device. Seven established hospitals in three Nigerian States were selected using purposive sampling. A respiratory support program was developed and implemented using the Pumani® bCPAP. Neonates <28 days old with severe RD, birth weight >1000g and breathing spontaneously, were eligible. The program lasted 22 months. Focus group discussions and in-depth interviews of healthcare workers and hospital administrators were used in program assessment. Content analysis of qualitative data completed. The staff reported that the bCPAP device was easy to use and effective. All staff reported comfort in eligible patient identification, effective set up and bCPAP administration. All study sites experienced varying degrees of electric power interruption and oxygen availability and affordability. Staff training, staffing disruptions, data collection challenges and use of improvised bCPAP contributed to low enrollment. Advocacy, direct program support, and innovation using locally available resources improved enrollment. Professional organization collaboration, competency-based training and peer mentoring contributed to program success. Thorough pre-program assessment, with comprehensive understanding of all aspects of the existing system within the local context which are likely to impact the introduction of a new program is important to implementation success.

Newborn care technology investments for LMIC settings: a CPAP approach

“…To drive investment considerations, understanding of the drivers of healthcare worker behaviour, systemic issues that limit implementation such as availability of oxygen and constant supply of electricity, 13 health ministry prioritisation of newborn health including flow of funds and procurement process for newborn care packages across the health system or facility level, tradeoff between needs such as purchasing essential medicines and supplies versus tools and devices, procurer choice of which CPAP device to purchase based on perceived value proposition of the device. All of these affect the design and ultimate uptake of CPAP and ancillary newborn care technologies and are necessary prerequisites when considering investments in a new product.…”