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Kebede AA, Taye BT, Wondie KY, Tiguh AE, Eriku GA, Mihret MS. Preparedness for neonatal emergencies at birth and associated factors among healthcare providers working at hospitals in northwest Ethiopia: A multi-center cross-sectional study. Heliyon 2021; 7:e08641. [PMID: 35005286 PMCID: PMC8715199 DOI: 10.1016/j.heliyon.2021.e08641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/19/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neonatal mortality remains a public health concern, especially in Southern Asia and Sub-Saharan Africa. Despite substantial efforts, the neonatal mortality rate is increasing from 29 per 1000 live births in 2016 to 33 per 1000 live births in 2019 in Ethiopia. To avert this unacceptably high mortality, the healthcare provider's readiness for neonatal emergencies at birth is crucial. Hence, this study aimed to assess healthcare providers' preparedness for neonatal emergencies at birth in northwest Ethiopia. METHODS A multicenter cross-sectional study was conducted at hospitals in northwest Ethiopia from November 15/2020 to March 10/2021. A simple random sampling technique was used to select 406 study participants. Data were collected through face-to-face interviews using a structured questionnaire, and direct observation and chart review using standardized checklists. The data were then entered into EPI INFO version 7.1.2 and exported to SPSS version 25 for analysis. Both bivariable and multivariable logistic regression analyses were undertaken. The level of significance was claimed based on the adjusted odds ratio (AOR) with a 95 % confidence interval (CI) at a p-value of ≤0.05. RESULTS The proportion of healthcare providers having adequate preparedness for neonatal emergencies was 60.1% (95% CI: 55.3, 64.8). The final model analysis illustrates that healthcare providers who received neonatal resuscitation training (AOR = 2.87; 95% CI: 1.74, 7.74) and working at the general hospital (AOR = 5.2; 95% CI: 1.96, 13.8) were adequately prepared for neonatal emergencies. On the other hand, healthcare providers who complained about workload or shortage of staff (AOR = 0.41; 95% CI: 0.26, 0.66) were poorly prepared for neonatal emergencies. CONCLUSION In this study, about two-fifths of the healthcare providers were inadequately prepared for neonatal emergencies at birth. Strengthening the provision of neonatal resuscitation training, deploying adequate healthcare professionals, and reducing the healthcare provider's workload would improve healthcare providers' preparedness for neonatal emergencies.
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Affiliation(s)
- Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Chaulagain DR, K. C. A, Wrammert J, Brunell O, Basnet O, Malqvist M. Effect of a scaled-up quality improvement intervention on health workers' competence on neonatal resuscitation in simulated settings in public hospitals: A pre-post study in Nepal. PLoS One 2021; 16:e0250762. [PMID: 33914798 PMCID: PMC8084235 DOI: 10.1371/journal.pone.0250762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 04/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Helping Babies Breathe (HBB) training improves bag and mask ventilation and reduces neonatal mortality and fresh stillbirths. Quality improvement (QI) interventions can improve retention of neonatal resuscitation knowledge and skills. This study aimed to evaluate the effect of a scaled-up QI intervention package on uptake and retention of neonatal resuscitation knowledge and skills in simulated settings. Methods This was a pre-post study in 12 public hospitals of Nepal. Knowledge and skills of trainees on neonatal resuscitation were evaluated against the set standard before and after the introduction of QI interventions. Results Altogether 380 participants were included for knowledge evaluation and 286 for skill evaluation. The overall knowledge test score increased from 14.12 (pre-basic) to 15.91 (post-basic) during basic training (p < 0.001). The knowledge score decreased over time; 15.91 (post-basic) vs. 15.33 (pre-refresher) (p < 0.001). Overall skill score during basic training (16.98 ± 1.79) deteriorated over time to 16.44 ± 1.99 during refresher training (p < 0.001). The proportion of trainees passing the knowledge test increased to 91.1% (post-basic) from 67.9% (pre-basic) which decreased to 86.6% during refresher training after six months. The knowledge and skill scores were maintained above the set standard (>14.0) over time at all hospitals during refresher training. Conclusion HBB training together with QI tools improves health workers’ knowledge and skills on neonatal resuscitation, irrespective of size and type of hospitals. The knowledge and skills deteriorate over time but do not fall below the standard. The HBB training together with QI interventions can be scaled up in other public hospitals. Trial registration This study was part of the larger Nepal Perinatal Quality Improvement Project (NePeriQIP) with International Standard Randomised Controlled Trial Number, ISRCTN30829654, registered 17th of May, 2017.
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Affiliation(s)
- Dipak Raj Chaulagain
- Department of Women’s and Children’s Health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Ashish K. C.
- Department of Women’s and Children’s Health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala University, Uppsala, Sweden
- Society of Public Health Physicians Nepal (SOPHPHYN), Kathmandu, Nepal
| | - Johan Wrammert
- Department of Women’s and Children’s Health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala University, Uppsala, Sweden
| | - Olivia Brunell
- Department of Women’s and Children’s Health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala University, Uppsala, Sweden
| | | | - Mats Malqvist
- Department of Women’s and Children’s Health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala University, Uppsala, Sweden
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Gurung R, Gurung A, Basnet O, Eilevstjønn J, Myklebust H, Girnary S, Shrestha SK, Singh D, Bastola L, Paudel P, Baral S, Kc A. REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal. BMC Pregnancy Childbirth 2020; 20:756. [PMID: 33272242 PMCID: PMC7712979 DOI: 10.1186/s12884-020-03456-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal. METHODS A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews. DISCUSSION This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN18148368 , date of registration-31 July 2018.
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Affiliation(s)
| | | | | | | | | | - Sakina Girnary
- Laerdal Medicine/Laerdal Global Health, Stavanger, Norway
| | | | - Dela Singh
- Pokhara Academy of Health Sciences, Pokhara, Nepal
| | | | - Prajwal Paudel
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | | | - Ashish Kc
- Society of Public Health Physician Nepal, Kathmandu, Nepal. .,Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, 1 tr, 752 37, Uppsala, Sweden.
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Dol J, Campbell-Yeo M, Murphy GT, Aston M, McMillan D, Richardson B. The impact of the Helping Babies Survive program on neonatal outcomes and health provider skills: a systematic review. ACTA ACUST UNITED AC 2019. [PMID: 29521869 DOI: 10.11124/jbisrir-2017-003535] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to evaluate the impact of the Helping Babies Survive program on neonatal outcomes and healthcare provider knowledge and skills. INTRODUCTION The Helping Babies Survive program consists of three modules: Helping Babies Breathe, Essential Care for Every Baby, and Essential Care for Small Babies. It was developed to reduce preventable newborn deaths through skill-based learning using simulation, learning exercises, and peer-to-peer training of healthcare providers in low-resource areas. Despite the widespread increase in healthcare provider training through Helping Babies Survive and the growing number of studies that have been conducted, there has been no systematic review of the Helping Babies Survive program to date. INCLUSION CRITERIA The review included studies on healthcare providers and/or birth attendants providing essential neonatal care during and post birth. Types of interventions were any Helping Babies Survive module (Helping Babies Breathe, Essential Care for Every Baby, Essential Care for Small Babies). Studies including experimental study designs with the following outcomes were considered: neonatal outcomes and/or healthcare provider knowledge and skills obtained, maintained, and used over time. METHODS PubMed, Embase, Web of Science, ProQuest Databases, Scopus and CINAHL were searched for published studies in English between January 2010 to December 2016. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Conflicts were solved through consensus with a third reviewer. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. Conflicts were solved through consensus with a third reviewer. Quantitative data was, where possible, pooled in statistical meta-analysis using RevMan (Copenhagen: The Nordic Cochrane Centre, Cochrane). Where statistical pooling was not possible the findings have been reported narratively. RESULTS A total of 17 studies were identified - 15 on Helping Babies Breathe (n = 172,685 infants and n = 2,261 healthcare providers) and two on Essential Care for Every Baby (n = 206 healthcare providers). No studies reported on Essential Care for Small Babies. Helping Babies Survive was found to significantly reduce fresh stillbirth rates and first day mortality rates, but was not found to influence stillbirth rates or mortality rates, measured at seven or 28 days post birth. Short-term improvements were significant in knowledge and skills scores but not significant in sustainability over time. Additionally, implementation of resuscitations skills in clinical practice related to the Helping Babies Breathe module including drying/stimulation, suction, and bag and mask ventilation did not show a significant increase after training even though the number of fresh stillbirth and first-day mortality rate decreased. CONCLUSIONS Helping Babies Survive has a significant positive impact on early neonatal outcomes, including fresh stillbirth and first-day mortality primarily through Helping Babies Breathe, but limited conclusions can be drawn about its impact on other neonatal outcomes. While Helping Babies Survive was found to improve immediate knowledge and skill acquisition, there is some evidence that one-time training may not be sufficient for sustained knowledge or the incorporation of key skills related to resuscitation into clinical practice. Continued research on the sustained knowledge and skills is needed to evaluate the long-term impact of the Helping Babies Survive program.
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Affiliation(s)
- Justine Dol
- Department of Health, Faculty of Health, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence, Dalhousie University, Halifax, Canada.,World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.,Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence, Dalhousie University, Halifax, Canada.,World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
| | - Gail Tomblin Murphy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence, Dalhousie University, Halifax, Canada.,World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
| | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence, Dalhousie University, Halifax, Canada.,World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Brianna Richardson
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence, Dalhousie University, Halifax, Canada
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Budhathoki SS, Gurung R, Ewald U, Thapa J, KC A. Does the Helping Babies Breathe Programme impact on neonatal resuscitation care practices? Results from systematic review and meta-analysis. Acta Paediatr 2019; 108:806-813. [PMID: 30582888 PMCID: PMC6590361 DOI: 10.1111/apa.14706] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/25/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022]
Abstract
AIM This paper examines the change in neonatal resuscitation practices after the implementation of the Helping Babies Breathe (HBB) programme. METHODS A systematic review was carried out on studies reporting the impact of HBB programmes among the literature found in Medline, POPLINE, LILACS, African Index Medicus, Cochrane, Web of Science and Index Medicus for the Eastern Mediterranean Region database. We selected clinical trials with randomised control, quasi-experimental and cross-sectional designs. We used a data extraction tool to extract information on intervention and outcome reporting. We carried out a meta-analysis of the extracted data on the neonatal resuscitation practices following HBB programme using Review Manager. RESULTS Four studies that reported on neonatal resuscitation practices before and after the implementation of the HBB programme were identified. The pooled results showed no changes in the use of stimulation (RR-0.54; 95% CI, 0.21-1.42), suctioning (RR-0.48; 95% CI, 0.18-1.27) and bag-and-mask ventilation (RR-0.93; 95% CI, 0.47-1.83) after HBB training. The proportion of babies receiving bag-and-mask ventilation within the Golden Minute of birth increased by more than 2.5 times (RR-2.67; 95% CI, 2.17-3.28). CONCLUSION The bag-and-mask ventilation within Golden minute has improved following the HBB programme. Implementation of HBB training improves timely initiation of bag-and-mask ventilation within one minute of birth.
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Affiliation(s)
- Shyam Sundar Budhathoki
- School of Public Health and Community Medicine B.P Koirala Institute of Health Sciences Dharan Nepal
| | | | - Uwe Ewald
- International Maternal and Child Health Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Jeevan Thapa
- School of Public Health and Community Medicine B.P Koirala Institute of Health Sciences Dharan Nepal
| | - Ashish KC
- International Maternal and Child Health Department of Women's and Children's Health Uppsala University Uppsala Sweden
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