Aftermath of a Clinical Trial: Evaluating the Sustainability of a Medical Device Intervention in Ghana

Abstract

A randomized controlled trial recently demonstrated that continuous positive airway pressure (CPAP) effectively decreases respiratory rate in children presenting to Ghanaian district hospitals with respiratory distress. A follow-up study 16 months later evaluated the extent to which the skills and equipment necessary for CPAP use have been maintained. Seven of eight CPAP machines were functional, but five of eight oxygen concentrators and three of four electric generators were non-functional. Nurses trained by US study personnel (first-generation) and nurses trained by Ghanaian nurses after the study (second-generation) were evaluated on CPAP knowledge and skills. Twenty-eight nurses participated in the study, 9 first-generation and 19 second-generation. First-generation trainees scored significantly higher than second-generation trainees on both skills and knowledge assessments (p = 0.003). Appropriate technical support and training must be ensured to address equipment maintenance. Protocolization of the training program, in conjunction with skills and knowledge assessment, may improve acquisition and retention among second- and future-generation trainees.

Continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label, cluster, crossover trial

“…Further work is needed to determine how best to scale up and maintain training of non-physician providers in the use of CPAP. 22 We found that mortality was associated with younger age, lower bodyweight, higher respiratory rate and lower oxygen saturation, which is consistent with other published data. 8,9,13,14,23 Survival was positively associated with study month: the later in the study a patient was enrolled, the more likely he or she was to survive.…”

Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework

“…Studies focused on sustainability at the provider level examined retention of health care workers and the challenging work conditions they experience at the end of a project. One study examined the sustainability of an equipment used during a clinical trial [ 32 ], while another evaluated sustainment at the community level [ 33 ].…”

“…Lack of communication about funding termination [ 57 ] 13. Lack of medical equipment and uncertainty about securing future funds for equipment [ 32 ] Community buy-in through volunteerism 1. Satisfaction of being able to contribute to community well-being [ 70 ] 2.…”

“…Record keeping and reporting; improved monitoring and reporting, quality improvement cycles initiated [ 33 , 50 ] 4. Development and accreditation of standard training, education, and evaluation materials along with training and oversight [ 41 , 45 , 48 , 63 , 32 ] 5. Integrity in money management [ 40 ] 6.…”

Key considerations prior to nasal high flow deployment in a Peruvian PICU from providers’ perspectives

“…This disparity is, in part, due to lack of resources to provide advanced paediatric respiratory care in many resource‐limited settings. Although multiple studies demonstrate the effectiveness of non‐invasive ventilation for paediatric respiratory failure in resource‐limited settings , sustainable use of this technology in these settings remains challenging .…”