Effect of Treatment of Premature Infants with Respiratory Distress Using Low-cost Bubble CPAP in a Rural African Hospital

Myhre, Jennifer A.; Immaculate, Mutisya; Okeyo, Bob; Anand, Matthew; Omoding, Anastacia; Myhre, Luke; Okeyo, L.; Barasa, Immaculate K.; Letchford, Stephen

doi:10.1093/tropej/fmw023

Cited by 26 publications

(28 citation statements)

References 6 publications

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“…Major complications like pneumothorax were not observed among the study participants. The findings from our study do not contradict other studies in low and middle income countries that showed great improvement of survival to discharge in preterm babies when treated with bCPAP [16][17][18][19][20]. Pieper and colleagues conducted a small non-randomized study in South Africa demonstrating increased survival rates of extremely immature babies with moderate to severe respiratory distress treated with nasal CPAP in the absence of surfactant replacement therapy and neonatal intensive care [17].…”

Section: Discussionsupporting

confidence: 69%

Treatment outcomes of Pumani bubble-CPAP versus oxygen therapy among preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania—Randomised trial

et al. 2020

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Background Respiratory distress syndrome (RDS) is the most common respiratory disease in premature babies and the major cause of morbidity and mortality among preterm babies. Effective treatment of these babies requires exogenous surfactant and/or mechanical ventilation but these are of limited availability in low and middle income countries. A cheaper, simpler and more accessible treatment for preterms with RDS called bubble-continuous positive airway pressure (bCPAP) has been reported to be effective in treating RDS in preterm babies with varying levels of effectiveness ranging from 42% to 85%. We aimed to implement and determine the efficacy of bCPAP and its immediate outcomes as compared to oxygen therapy in preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania. Method A randomized control trial, conducted from December 2016 to May 2017, included all preterm babies admitted at the neonatal care unit presenting with signs of respiratory distress and meeting the inclusion criteria. The primary outcome was survival while the secondary outcomes were treatment duration, duration of hospital stay and treatment complications. Results A total of 824 babies were admitted in the neonatal care unit during the study period. Of these, 187 babies were preterm and 48 babies were recruited and randomized (25 bCPAP vs 23 oxygen). The overall survival to discharge for all eligible participants (n = 48) was

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Section: Discussionsupporting

confidence: 69%

Treatment outcomes of Pumani bubble-CPAP versus oxygen therapy among preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania—Randomised trial

et al. 2020

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“…Health workers at district hospitals emphasized barriers of training gaps exacerbated by staff rotations and shortages. Studies of bubble CPAP in Malawi [ 24 ], Uganda [ 25 ], and Kenya [ 26 ] also found that nursing shortages in rural district hospital nurseries were a key barrier and raised the concern that bubble CPAP could exacerbate demands on health workers. Interviews with staff at district hospitals highlighted the requirement of nurses’ internal motivation to prioritize bubble CPAP use within their time and labor capacities and accept the responsibility for more frequent monitoring and elements of personal confidence and innovativeness to try novel systems.…”

Section: Discussionmentioning

confidence: 99%

Scaling up newborn care technologies from tertiary- to secondary-level hospitals in Malawi: an implementation case study of health professional perspectives on bubble CPAP

Kinshella

Salimu

Hiwa

et al. 2020

Implement Sci Commun

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Background While Malawi has achieved success in reducing overall under-five mortality, reduction of neonatal mortality remains a persistent challenge. There has, therefore, been a push to strengthen the capacity for quality newborn care at district hospitals through the implementation of innovative neonatal technologies such as bubble continuous positive airway pressure (CPAP). This study investigates tertiary- versus secondary-level hospital differences in capacities for bubble CPAP use and implications for implementation policies. Methods A secondary analysis of interviews was conducted with 46 health workers at one tertiary hospital and three secondary hospitals in rural Southern Malawi. Grounded theory was utilized to explore the emerging themes according to health worker cadres (nurse, clinician, district health management) and facility level (tertiary- and secondary-level facilities), which were managed using NVivo 12 (QSR International, Melbourne, Australia). Results We identified frequent CPAP use and the availability of neonatal nurses, physicians, and reliable electricity as facilitators for CPAP use at the tertiary hospital. Barriers at the tertiary hospital included initiation eligibility disagreements between clinicians and nurses and insufficient availability of the CPAP machines. At secondary-level hospitals, the use was supported by decision-making and initiation by nurses, involving caretakers to assist in monitoring and reliable availability of CPAP machines. Bubble CPAP was hindered by unreliable electricity, staffing shortages and rotation policies, and poor systems of accountability. Conclusion While this study looked at the implementation of bubble CPAP in Malawi, the findings may be applicable for scaling up other novel neonatal technologies in low-resource settings. Implementation policies must consider staffing and management structures at different health services levels for effective scale-up.

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“…Many studies [5][6][7]11,12,29 have shown CPAP to be an effective treatment in low-resource settings, but complex CPAP machines are expensive and require a high level of expertise to administer and maintain. Therefore, a simple, inexpensive device is needed.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings

2018

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Effect of Treatment of Premature Infants with Respiratory Distress Using Low-cost Bubble CPAP in a Rural African Hospital

Abstract: BCPAP has contributed significantly to favorable outcomes for preterm infants with RDS at AIC Kijabe Hospital. The use of this simple technology should be considered and studied for expansion to all hospitals in Kenya that care for preterm infants.

Cited by 26 publications

References 6 publications

Treatment outcomes of Pumani bubble-CPAP versus oxygen therapy among preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania—Randomised trial

Treatment outcomes of Pumani bubble-CPAP versus oxygen therapy among preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania—Randomised trial

Scaling up newborn care technologies from tertiary- to secondary-level hospitals in Malawi: an implementation case study of health professional perspectives on bubble CPAP

Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings

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