Effective training-of-trainers model for the introduction of continuous positive airway pressure for neonatal and paediatric patients in Kenya

Abstract

Notes on contributorsBernard Olayo is a public health specialist and an entrepreneur from Kenya. He is the founder of the Center for Public Health and Development, a non-profit which has designed and developed two successful social enterprises -MediQuip Global (biomedical equipment repair and maintenance solutions) and Hewa Tele (a public-private venture delivering affordable oxygen in remote areas). He has over 14 years of experience managing complex public health programs in resource-limited settings in 15 countries across the globe. He is also a technical team member on several World Bank projects, primarily as a technical advisor to a number of ministries of health. Caroline Kendi Kirigia is a public health practitioner with training as a clinical officer, in project management, and a Masters in public health. Her 13 years of work experience ranges from HIV and TB prevention, care and treatment and team leadership with the University of California San Francisco and the Kenya Medical Research Institute's FACES programme to supporting the development of continuous quality improvement systems with HealthStrat and the Center for Public Health and Development in Kenya where she currently works in programmes. Her current work covers her interest areas of mental health, maternal health, newborn and child health. Jacquie Narotso Oliwa is a paediatrician, clinical epidemiologist, lecturer and a research fellow working on improving case detection of TB in children. She has 10 years of experience in medical education as a trainer for Paediatric TB, paediatric HIV Comprehensive Care Course; Paediatric TB; Paediatric Life support courses. She teaches child health and research methods at the University of Nairobi and has worked in health systems research collaborating with the Kenyan Ministry of Health and government hospitals in various quality improvement projects, pragmatic clinical observational studies trials and conducting systematic reviews. Odero Nicholas Agai is a Consultant Paediatrician and Child Health Specialist with 10 years hands-on experience both in the public and private sectors. He is also affiliated to The Centre for Public Health and Development, Kenya where he is a consultant and is actively involved in training of health care workers on innovative technology that are designed to reduce neonatal and childhood morbidity and mortality.

Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

“…1, Table 3). This included six case studies or series of neonates who received bubble CPAP [19,20,22,23,29,34], four observational cohort or cross-sectional studies [26,30,31,33], three uncontrolled before-and-after studies [12,25,32] and four case-control intervention studies that compared novel use of bubble CPAP systems or implementation components with local standards of existing care [5,21,24,28]. All four case-control intervention studies were quasi-experimental and there were no randomized controlled trials.…”

“…Four out of the five low-cost standalone systems used the Pumani bubble CPAP device, which was developed in Malawi [5,23,24,26], and one study used politeCPAP, which was recently developed in Nigeria [21]. DeVilbiss IntelliPAP [28] and Fisher Paykel [32] bubble CPAP systems were the two commercial versions used. Most studies were conducted in tertiary level hospitals (11 studies; 65%), with four (24%) conducted in secondary level rural referral or district hospitals and two (12%) included both tertiary and district hospitals.…”

“…An early study of bubble CPAP in Malawi found that there were only two nurses available for an average of 30 neonates [34]. Understaffing was associated with limited availability for training, which was compounded with other challenges such as high turnover of nurses and doctors necessitating repeated trainings of new staff [25,28,[30][31][32]. Consequently, studies noted gaps in the training that was available.…”

“…Four studies highlighted the importance of regular and interactive training and that it could serve as a facilitator to implementation [24,25,28,31]. The effective training used a wide range of methods including comprehensive presentations on respiratory physiology, indications to initiate bubble CPAP, contraindications and monitoring complemented by instructional videos, the use of case examples, simulation scenarios with mannequins and real-time supervision and utilization of bubble CPAP on an infant [24,25,28,31]. Provider-to-provider clinical mentorship models supported training efforts, especially when clinical mentors were trained in how to train others to use bubble CPAP [28,30,31].…”

“…The effective training used a wide range of methods including comprehensive presentations on respiratory physiology, indications to initiate bubble CPAP, contraindications and monitoring complemented by instructional videos, the use of case examples, simulation scenarios with mannequins and real-time supervision and utilization of bubble CPAP on an infant [24,25,28,31]. Provider-to-provider clinical mentorship models supported training efforts, especially when clinical mentors were trained in how to train others to use bubble CPAP [28,30,31]. Experience sharing trips to effective neonatal units and intermittent refresher trainings were helpful in supporting knowledge and skill development; this built motivation and morale as health providers regarded it as an investment in their professional capacities [25,31].…”