‘Sometimes you are forced to play God…’: a qualitative study of healthcare worker experiences of using continuous positive airway pressure in newborn care in Kenya

Abstract

​ObjectiveTo explore the experiences of using continuous positive airway pressure (CPAP) in newborn care among healthcare workers in Kenya, and to identify factors that would promote successful scale-up.​Design and settingA qualitative study using key informant interviews and focus group discussions, based at secondary and tertiary level hospitals in Kenya.​ParticipantsHealthcare workers in the newborn units providing CPAP.​Primary and secondary outcome measureFacilitators and barriers of CPAP use in newborn care in Kenya.​Results16 key informant interviews and 15 focus group discussions were conducted across 19 hospitals from September 2017 to February 2018. Main barriers reported were: (1) inadequate infrastructure to support the effective delivery of CPAP, (2) shortage of skilled staff rendering it difficult for the available staff to initiate or monitor infants on CPAP and (3) inadequate knowledge and training of staff that inhibited the safe care of infants on CPAP. Key facilitators reported were positive patient outcomes after CPAP use that increased staff confidence and partnership with caregivers in the management of newborns on CPAP. Healthcare workers in private/mission hospitals had more positive experiences of using CPAP in newborn care as the relevant support and infrastructure were available.​ConclusionCPAP use in newborn care is valued by healthcare workers in Kenya. However, we identified key challenges that threaten its safe use and sustainability. Further scale-up of CPAP in newborn care should ensure that staff members have ready access to optimal training on CPAP and that there are enough resources and infrastructure to support its use.EthicsThis study was approved through the appropriate ethics committees in Kenya and the UK (see in text) with written informed consent for each participant.

Impact of secondary and tertiary neonatal interventions on neonatal mortality in a low- resource limited setting hospital in Uganda: a retrospective study

“…Other studies have also reported mentorship, frequent training and the use of clinical algorithms can improve the use of CPAP in low-resource limited settings. [26][27][28] The use of animal derived surfactant in preterm infants with established respiratory distress syndrome is associated with substantial decreases in risks of pneumothorax (by 58%), pulmonary interstitial emphysema (55%) and neonatal mortality (32%). 29 The introduction of surfactant administration in 2014 in our hospital likely contributed to the further reduction in prematurityrelated deaths.…”