Gaps in neonatal thermal care in low-resource settings: A web-based survey of healthcare workers.

Abstract

Objective To explore the gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings. Methods We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings globally. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the peripheral temperature by hand-touch. The usefulness of the core temperature was valued higher than that of the peripheral temperature as an indicator of cold stress, with 70% and 58% agreement, respectively. Opinions diverged regarding the peripheral temperatures, including apparent inaccuracy compared to rectal or axillary temperature. Preferences on rewarming strategies widely differed among participants and so did the availability of warming equipment in their institutions. Conclusions We identified the general acknowledgment of the importance of the WHO warm chain but also its limited practice. We also identified that an inadequate understanding of cold stress underestimates the potential benefits of peripheral temperatures and leads to missed opportunities for timely prevention of hypothermia. Furthermore, lack of consistent guidance on equipment for rewarming hypothermic neonates hampers recovery.

Ending Neonatal Deaths From Hypothermia in Sub-Saharan Africa: Call for Essential Technologies Tailored to the Context

“…In SSA, newborns are at particularly high risk of hypothermia due to a mix of physiological features (i.e., high incidence of low-weight at birth and prematurity), cultural beliefs (i.e., delayed breastfeeding/skin-to-skin contact/drying and wrapping, late hospital admission, newborn bathing/oil massage right after birth), and socioeconomic factors (i.e., high prevalence of home deliveries, absence of skilled care at delivery and unavailability of medical devices, including for post-delivery transport, poverty, and out-of-pocket payments for health services). These factors merge with a critical health care condition of shortage in essential infrastructures (i.e., neonatal units and equipment) and a lack of awareness of the risks associated to hypothermia (i.e., absence of skilled personnel and insufficient or absent training for hypothermia prevention and treatment) ( 9 – 13 ).…”

“…It comes with no surprise, hence, that the epidemiological prevalence of neonatal hypothermia is difficult to evaluate in these countries, with estimates ranging from 32 to 85% in hospital-born infants, and from 11 to 92% for home deliveries ( 6 ). Alongside, the prevalence of hypothermia in SSA hospitals spans from 8% within the first 12 h after birth to 85% in the case of hospital admission ( 13 ). In general, such broad intervals reflect a lack in the knowledge about the incidence and prevalence of hypothermia, both from a clinical and an epidemiological perspective ( 6 ).…”

“…Despite these guidelines, neonatal hypothermia remains a major determinant of infant death in SSA countries. Indeed, some measures may be insufficient or unpractical in the SSA context ( 9 – 13 ).…”

“…Moreover, the prompt drying and wrapping, placing the infant onto the mother's chest for skin-to-skin contact, and the early initiation of breastfeeding lack consistent practice ( 41 ). In rural regions of SSA, both healthcare providers and mothers-to-be have little adequate knowledge of neonatal physiology, appropriate handling, and even simple existing thermal care solutions ( 13 , 41 ).…”