Limited resources restrict the provision of adequate neonatal respiratory care in the countries of Africa

Abstract

Aim: Over two thirds of newborn deaths occur in Africa and South Asia, and respiratory failure is a major contributor of these deaths. The exact availability of continuous positive airway pressure (CPAP) and surfactant in Africa is unknown. The aim of this study was to describe the availability of newborn respiratory care treatments in the countries of Africa.Methods: Surveys, in English, French and Portuguese, were sent to neonatal leaders in all 48 continental countries and the two islands with populations over 1 million.Results: Forty-nine (98%) countries responded. Twenty-one countries reported less than 50 paediatricians, and 12 countries had no neonatologists. Speciality neonatal nursing was recognised in 57% of countries. Most units were able to provide supplemental oxygen. CPAP was available in 63% and 67% of the most well-equipped government and private hospitals. Surfactant was available in 33% and 39% of the most well-equipped public and private hospitals, respectively. Availability of CPAP and surfactant was greatly reduced in smaller cities. Continuous oxygen saturation monitoring was only available in 33% of countries. Conclusion: The availability of proven life-saving interventions in Africa is inadequate.There is a need to sustainably improve availability and use of these interventions.

Respiratory Interventions for Preterm Infants in LMICs: A Prospective Study From Cape Town, South Africa

“…However, the mortality rate compares favorably to many other LMICs' results ( 2 , 18 – 20 ). Although they serve a similar population to that found in many low-resourced areas, GSH and MMH neonatal units are much better resourced than many government institutions in LMICs ( 6 ).…”

“…Despite the evidence that CPAP is an effective treatment modality in preterm infants with respiratory distress in LMICs, the availability and utilization of this promising intervention remains low in Africa ( 6 , 16 ). Although universal availability of CPAP to treat respiratory distress in preterm infants in LMICs may lead to a decrease in mortality, the low-resource setting in which the intervention is being implemented needs to be considered.…”

“…The WHO has made a strong recommendation for the use of this promising intervention ( 9 ). Despite being included in the WHO Essential Drug List, the coverage of surfactant is estimated to be <40% in African countries ( 6 ).…”

“…They provide tertiary and secondary level care, respectively, for a drainage area of 40,000 deliveries per annum. Although these public hospitals are lower resourced than their private for-profit counterparts in South Africa, they are better resourced than most other units in Africa ( 6 ).…”

“…In 2020, only 63% of African countries had any access to CPAP and only 33% had access to surfactant replacement therapy (SRT). Further inequality is evident when comparing public to private hospitals and urban to rural areas; for example, only 28% of countries had access to CPAP in more than 10% of their cities, leaving most preterm infants without this effective intervention ( 6 ).…”