Implementation of a Bubble CPAP Treatment Program for Sick Newborns in Nakuru, Kenya: A Quality Improvement Initiative

Switchenko, Nora; Kibaru, Elizabeth; Tsimbiri, Pamela; Grubb, Peter H.; Berry, Ann Anderson; Fassl, Bernhard

doi:10.1177/2333794x20939756

Cited by 4 publications

(2 citation statements)

References 18 publications

(19 reference statements)

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“…A focus of the NEST360 alliance is to improve newborn medical device and maintenance readiness in hospitals. Lack of appropriate device maintenance can lead to hospitals having large numbers of non-functional equipment known as “equipment graveyards”, limiting the ability to provide life-saving interventions that require medical devices [ 25 , 26 ]. Level-2+ scores are also useful for understanding gaps in readiness.…”

Section: Discussionmentioning

confidence: 99%

Quantifying health facility service readiness for small and sick newborn care: comparing standards-based and WHO level-2 + scoring for 64 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania

Penzias,

Bohne,

Gicheha

et al. 2024

BMC Pediatr

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Background Service readiness tools are important for assessing hospital capacity to provide quality small and sick newborn care (SSNC). Lack of summary scoring approaches for SSNC service readiness means we are unable to track national targets such as the Every Newborn Action Plan targets. Methods A health facility assessment (HFA) tool was co-designed by Newborn Essential Solutions and Technologies (NEST360) and UNICEF with four African governments. Data were collected in 68 NEST360-implementing neonatal units in Kenya, Malawi, Nigeria, and Tanzania (September 2019-March 2021). Two summary scoring approaches were developed: a) standards-based, including items for SSNC service readiness by health system building block (HSBB), and scored on availability and functionality, and b) level-2 + , scoring items on readiness to provide WHO level-2 + clinical interventions. For each scoring approach, scores were aggregated and summarised as a percentage and equally weighted to obtain an overall score by hospital, HSBB, and clinical intervention. Results Of 1508 HFA items, 1043 (69%) were included in standards-based and 309 (20%) in level-2 + scoring. Sixty-eight neonatal units across four countries had median standards-based scores of 51% [IQR 48–57%] at baseline, with variation by country: 62% [IQR 59–66%] in Kenya, 49% [IQR 46–51%] in Malawi, 50% [IQR 42–58%] in Nigeria, and 55% [IQR 53–62%] in Tanzania. The lowest scoring was family-centred care [27%, IQR 18–40%] with governance highest scoring [76%, IQR 71–82%]. For level-2 + scores, the overall median score was 41% [IQR 35–51%] with variation by country: 50% [IQR 44–53%] in Kenya, 41% [IQR 35–50%] in Malawi, 33% [IQR 27–37%] in Nigeria, and 41% [IQR 32–52%] in Tanzania. Readiness to provide antibiotics by culture report was the highest-scoring intervention [58%, IQR 50–75%] and neonatal encephalopathy management was the lowest-scoring [21%, IQR 8–42%]. In both methods, overall scores were low (< 50%) for 27 neonatal units in standards-based scoring and 48 neonatal units in level-2 + scoring. No neonatal unit achieved high scores of > 75%. Discussion Two scoring approaches reveal gaps in SSNC readiness with no neonatal units achieving high scores (> 75%). Government-led quality improvement teams can use these summary scores to identify areas for health systems change. Future analyses could determine which items are most directly linked with quality SSNC and newborn outcomes.

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Section: Discussionmentioning

confidence: 99%

Quantifying health facility service readiness for small and sick newborn care: comparing standards-based and WHO level-2 + scoring for 64 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania

Penzias,

Bohne,

Gicheha

et al. 2024

BMC Pediatr

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“…The provision of respiratory support, however, cannot occur in a vacuum-and settings must ensure concurrent robust provision of thermoregulation, nutritional support PLOS GLOBAL PUBLIC HEALTH and infection management as well [45]. bCPAP implementation requires training, clinical mentorship and post-implementation support as well as adequate and consistent staffing [8,14,28,46,47]. For sites ready for bCPAP implementation where higher priced devices are out of reach, further study on the practicality and implementation of very low cost devices including the PATH bCPAP device may be ideal.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and usability of a very low-cost bubble continuous positive airway pressure device including oxygen blenders in a Ugandan level two newborn unit

Hedstrom

Nyonyintono²,

Saxon³

et al. 2023

PLOS Glob Public Health

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Background Preterm birth and resulting respiratory failure is a leading cause of newborn death- the majority of which occur in resource-constrained settings and could be prevented with bubble continuous positive airway pressure (bCPAP). Commercialized devices are expensive, however, and sites commonly use improvised devices utilizing 100% oxygen which can cause blindness. To address this, PATH and a multidisciplinary team developed a very low-cost bCPAP device including fixed-ratio oxygen blenders. Objective We assessed feasibility of use of the device on neonatal patients as well as the usability and acceptability of the device by healthcare workers. This study did not evaluate device effectiveness. Methods The study took place in a Ugandan level two unit. Neonates with respiratory failure were treated with the bCPAP device. Prospective data were collected through observation as well as likert-style scales and interviews with healthcare workers. Data were analyzed using frequencies, means and standard deviation and interviews via a descriptive coding method. Retrospectively registered via ClinicalTrials.gov number NCT05462509. Results Fourteen neonates were treated with the bCPAP device in October—December 2021. Patients were born onsite (57%), with median weight of 1.3 kg (IQR 1–1.8). Median treatment length was 2.5 days (IQR 2–6). bCPAP was stopped due to: improvement (83%) and death (17%). All patients experienced episodes of saturations >95%. Median time for device set up: 15 minutes (IQR 12–18) and changing the blender: 15 seconds (IQR 12–27). After initial device use, 9 out of 9 nurses report the set-up as well as blender use was “easy” and their overall satisfaction with the device was 8.5/10 (IQR 6.5–9.5). Interview themes included the appreciation for the ability to administer less than 100% oxygen, desire to continue use of the device, and a desire for additional blenders. Conclusions In facilities otherwise using 100% oxygen, use of the bCPAP device including oxygen blenders is feasible and acceptable to healthcare workers. Trial registration ClinicalTrials.gov, Identifier NCT05462509.

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The introduction of nursing led bubble-CPAP in a neonatal unit in Ghana: A 32-month observational report

Fordjour,

Washburn,

Darko

et al. 2023

International Journal of Africa Nursing Sciences

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Implementation of a Bubble CPAP Treatment Program for Sick Newborns in Nakuru, Kenya: A Quality Improvement Initiative

Cited by 4 publications

References 18 publications

Quantifying health facility service readiness for small and sick newborn care: comparing standards-based and WHO level-2 + scoring for 64 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania

Quantifying health facility service readiness for small and sick newborn care: comparing standards-based and WHO level-2 + scoring for 64 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania

Feasibility and usability of a very low-cost bubble continuous positive airway pressure device including oxygen blenders in a Ugandan level two newborn unit

The introduction of nursing led bubble-CPAP in a neonatal unit in Ghana: A 32-month observational report

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