Barriers to and Facilitators for Newborn Resuscitation in Malawi, Africa

Abstract

Newborn resuscitation is a key component of efforts to reduce neonatal morbidity and mortality. This article reports the findings of focus groups conducted to explore the barriers and facilitators present for obstetric nurse providers in a central urban hospital in Malawi regarding the training and provision of neonatal resuscitation. All obstetric nurse providers in this setting participated in focus groups; these groups identified 4 themes: 1) confidence in their skills in assessing newborns and recognizing the need for resuscitation, 2) a lack of resources, 3) facilitators who would enable them to introduce resuscitation, and 4) solutions to the current problems. Resource shortages and barriers to providing care included availability of staff, equipment, and supplies; labor ward geography; ethical dilemmas; and the lack of standard protocols regarding newborn resuscitation. Facilitators were professional experience and the critical load of deliveries performed. Solutions to barriers included small resource additions as well as long-term policy changes. With standard policy and protocols, experienced, confident nurses could overcome the barriers to providing newborn resuscitation. This group identified ways to change systems to decrease infant mortality, thereby improving the health and quality of life of women receiving care in Malawi.

Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania

“…After the introduction of HBB, health-care facilities in Tanzania were equipped with basic resuscitation equipment, therefore, a lack of equipment was not mentioned as a barrier, as has been reported in other low-income countries [15,16]. The World Health Organization (WHO) recommends the preparation of delivery equipment and supplies, including newborn resuscitation equipment, whenever delivery is anticipated [33].…”

“…A lack of equipment, inadequate skills and knowledge, and ineffective communication are among the factors reported to hinder effective resuscitation, while training and good education are thought to decrease newborn morbidity and mortality [15,16]. Because low-income countries contribute significantly to the burden of intrapartum asphyxia, there is a need to better understand the context-specific factors that affect effective ventilation within these regions.…”

Challenges Experienced by Midwives Working in Rural Communities of the Bongo District in the Upper East Region of Ghana. A Qualitative Study

“…Also a study nding concerning African countries documented that inadequate sta ng and excessive overtime work was found to compromise womens safety and the midwifery staff as well [27]. The over demanding workload could place midwives in an ethical dilemma on how to prioritize care: in Malawi nurse-midwives mentioned of the daily problem of indecisions of who to care for; whether the newborn or the mother, or even another mother or another newborn [28]. The World Health Report in 2006 identi ed Ghana among 36 countries in SSA facing health workforce crisis [29] which necessitated government interventions through the Ministry of Health to address a myriad of health workforce challenges especially nurses and midwives.…”

Studi Kualitatif : Pelayanan Rujukan Asfiksia Bayi Baru Lahir di Kabupaten Cirebon Jawa Barat

“…Hal tersebut disebabkan oleh ketrampilan petugas yang masih kurang, alat resusitasi neonatus yang tidak tersedia di bagian UGD, serta prosedur penanganan kasus rujukan harus melalui bagian UGD terlebih dahulu, sehingga penanganan menjadi terlambat. Penelitian di 8 propinsi Afrika Selatan, 11 dan Malawi (Afrika), 12 menemukan hasil yang sama, yaitu manajemen asfiksia BBL di RS yang tidak optimal, sebagai akibat jumlah staf dan alat resusitasi neonatus di RS kurang. Juga terbukti bahwa prosedur penanganan pasien rujukan di RS Blantyre, Malawi, Afrika dan kemampuan petugas bagian UGD yang masih kurang merupakan salah satu penyebab angka kematian anak yang dirujuk ke RS tersebut tinggi.…”