Training and well-equipped facility increases the odds of skills of health professionals on helping babies breathe in public hospitals of Southern Ethiopia: cross-sectional study

Neonatal resuscitation in Eastern Africa: health care providers' level of knowledge and its determinants. A systematic review and meta-analysis

BACKGROUND

Even though effective neonatal resuscitation prevents the consequences of neonatal death related to birth asphyxia, a significant portion of healthcare personnel lacked understanding or performed it inconsistently. It is critical to have a comprehensive study that demonstrates the overall level of knowledge of healthcare providers regarding neonatal resuscitation in Eastern Africa.

METHODS

Articles were searched from Science Direct, JBI databases, Web of Sciences, PubMed, and Google Scholar. The primary outcome was the level of knowledge of health care providers regarding neonatal resuscitation. Data were analyzed using Stata version 18 statistical software. The overall estimates with a 95% confidence interval were estimated using a random effect model.

RESULTS

In this meta-analysis study, 7916 healthcare providers were included. The overall level of knowledge on neonatal resuscitation among healthcare providers in Eastern Africa was 59% [95% CI: 48-70]. Trained health care providers (OR = 3.63, 95% CI: 2.26, 5.00), and work experience of 5 years and above (OR = 2.08, 95% CI: 1.00, 3.16) were determinants of the level of knowledge. However, the level of education and availability of equipment were found to be insignificantly associated with the level of knowledge.

CONCLUSIONS

The results of this meta-analysis showed that healthcare professionals in Eastern Africa lacked sufficient knowledge about neonatal resuscitation. Having 5 years of work experience and training in neonatal resuscitation was found to be strongly associated with knowledge level. Thus, continuing education, training courses, and frequent updates on neonatal resuscitation protocols are required for healthcare professionals.

Mothers' acceptability of using novel technology with video and audio recording during newborn resuscitation: A cross-sectional survey

OBJECTIVE

This study aims to assess the acceptability of a novel technology, MAchine Learning Application (MALA), among the mothers of newborns who required resuscitation.

SETTING

This study took place at Bharatpur Hospital, which is the second-largest public referral hospital with 13 000 deliveries per year in Nepal.

DESIGN

This is a cross-sectional survey.

DATA COLLECTION AND ANALYSIS

Data collection took place from January 21 to February 13, 2022. Self-administered questionnaires on acceptability (ranged 1-5 scale) were collected from participating mothers. The acceptability of the MALA system, which included video and audio recordings of the newborn resuscitation, was examined among mothers according to their age, parity, education level and technology use status using a stratified analysis.

RESULTS

The median age of 21 mothers who completed the survey was 25 years (range 18-37). Among them, 11 mothers (52.4%) completed their bachelor's or master's level of education, 13 (61.9%) delivered first child, 14 (66.7%) owned a computer and 16 (76.2%) carried a smartphone. Overall acceptability was high that all participating mothers positively perceived the novel technology with video and audio recordings of the infant's care during resuscitation. There was no statistical difference in mothers' acceptability of MALA system, when stratified by mothers' age, parity, or technology usage (p>0.05). When the acceptability of the technology was stratified by mothers' education level (up to higher secondary level vs. bachelor's level or higher), mothers with Bachelor's degree or higher more strongly felt that they were comfortable with the infant's care being video recorded (p = 0.026) and someone using a tablet when observing the infant's care (p = 0.046). Compared with those without a computer (n = 7), mothers who had a computer at home (n = 14) more strongly agreed that they were comfortable with someone observing the resuscitation activity of their newborns (71.4% vs. 14.3%) (p = 0.024).

CONCLUSION

The novel technology using video and audio recordings for newborn resuscitation was accepted by mothers in this study. Its application has the potential to improve resuscitation quality in low-and-middle income settings, given proper informed consent and data protection measures are in place.

Usability, acceptability and feasibility of a novel technology with visual guidance with video and audio recording during newborn resuscitation: a pilot study

OBJECTIVE

Inadequate adherence to resuscitation for non-crying infants will have poor outcome and thus rationalise a need for real-time guidance and quality improvement technology. This study assessed the usability, feasibility and acceptability of a novel technology of real-time visual guidance, with sound and video recording during resuscitation.

SETTING

A public hospital in Nepal.

DESIGN

A cross-sectional design.

INTERVENTION

The technology has an infant warmer with light, equipped with a tablet monitor, NeoBeat and upright bag and mask. The tablet records resuscitation activities, ventilation sound, heart rate and display time since birth. Healthcare providers (HCPs) were trained on the technology before piloting.

DATA COLLECTION AND ANALYSIS

HCPs who had at least 8 weeks of experience using the technology completed a questionnaire on usability, feasibility and acceptability (ranged 1-5 scale). Overall usability score was calculated (ranged 1-100 scale).

RESULTS

Among the 30 HCPs, 25 consented to the study. The usability score was good with the mean score (SD) of 68.4% (10.4). In terms of feasibility, the participants perceived that they did not receive adequate support from the hospital administration for use of the technology, mean score (SD) of 2.44 (1.56). In terms of acceptability, the information provided in the monitor, that is, time elapsed from birth was easy to understand with mean score (SD) of 4.60 (0.76).

CONCLUSION

The study demonstrates reasonable usability, feasibility and acceptability of a technological solution that records audio visual events during resuscitation and provides visual guidance to improve care.

Facility and care provider emergency preparedness for neonatal resuscitation in Kano, Nigeria

Introduction

The knowledge, attitude, and practice of emergency neonatal resuscitation are critical requirements in any facility that offers obstetric and neonatal services. This study aims to conduct a needs assessment survey and obtain individual and facility-level data on expertise and readiness for neonatal resuscitation. We hypothesize that neonatal emergency preparedness among healthcare providers in Kano, Nigeria is associated with the level of knowledge, attitudinal disposition, practice and equipment availability at the facility level.

Methods

A semi-structured, self-administered questionnaire was administered to a cross-section of health providers directly involved with neonatal care (n = 112) and attending a neonatal resuscitation workshop in Kano state. Information regarding knowledge, attitude, practice and facility preparedness for neonatal resuscitation was obtained. Bloom’s cut-off score and a validated basic emergency obstetric and neonatal care assessment tool were adopted to categorize outcomes. Multivariable logistic regression was employed to determine independent predictors of knowledge and practice.

Results

Almost half (48% and 42% respectively) of the respondents reported average level of self-assessed knowledge and comfort during resuscitation. Only 7% (95% CI:3.2–13.7) and 5% (95% CI:2.0–11.4) of health providers demonstrated good knowledge and practice scores respectively, with an overall facility preparedness of 46%. Respondents’ profession as a physician compared to nurses and midwives predicted good knowledge (aOR = 0.08, 95% CI: 0.01–0.69; p = 0.01), but not practice.

Conclusion

Healthcare provider’s knowledge and practice including facility preparedness for emergency neonatal resuscitation were suboptimal, despite the respondents’ relatively high self-assessed attitudinal perception. Physicians demonstrated higher knowledge compared to other health professionals. The low level of respondents’ awareness, practice, and facility readiness suggest the current weak state of secondary health systems in Kano.

A mobile cesarean birth center as a solution to improve access to surgical birth in rural Ethiopia: a mixed methods research protocol

BACKGROUND

As an evidence-based intervention to prevent maternal and neonatal morbidity and mortality, cesarean birth at rates of under 2%, which is the case in rural Southwest Ethiopia, is an unacceptable public health problem and represents an important disparity in the use of this life-saving treatment compared to more developed regions. The objective of this study is to explore an innovative clinical solution (a mobile cesarean birth center) to low cesarean birth rates resulting from the Three Delays to emergency obstetric care in isolated and underserved regions of Ethiopia, and the world.

METHODS

We will use mixed but primarily qualitative methods to explore and prepare the mobile cesarean birth center for subsequent implementation in communities in Bench Sheko and West Omo Zones. This will involve interviews and focus groups with key stakeholders and retreat settings for user-centered design activities. We will present stakeholders with a prototype surgical truck that will help them conceive of the cesarean birth center concept and discuss implementation issues related to staffing, supplies, referral patterns, pre- and post-operative care, and relationship to locations for vaginal birth.

DISCUSSION

Completion of our study aims will allow us to describe participants' perceptions about barriers and facilitators to cesarean birth and their attitudes regarding the appropriateness, acceptability, and feasibility of a mobile cesarean birth center as a solution. It will also result in a specific, measurable, attainable, relevant, and timely (SMART) implementation blueprint(s), with implementation strategies defined, as well as recruitment plans identified. This will include the development of a logic model and process map, a timeline for implementation with strategies selected that will guide implementation, and additional adaptation/adjustment of the mobile center to ensure fit for the communities of interest.

TRIAL REGISTRATION

There is no healthcare intervention on human participants occurring as part of this research, so the study has not been registered.

Knowledge Outcome of Essential Care for Every Baby Training in Southern Nations, Nationalities, and People's Region, Ethiopia: A Pre- and Post-Test Study

This study was aimed to evaluate the knowledge outcome of ECEB training given to reduce neonatal mortality in Ethiopia. The study was conducted by using data from training given for 98 health professionals. Data were entered into Epi info7 and analyzed by SPSS version 21. Accordingly, the paired sample T-test, the independent sample t-test, and one way ANOVA were calculated at P-value <.05. Likewise, the mean knowledge score of the trainees increased from 59.10 (SD ± 13.180) before the training to 73.73 (SD ± 14.173) after the training. The increment was statistically significant (t (97) = 11.684, CI = 12.147-17.118, P < 0.001). The mean knowledge score was significantly varied between female and male trainees at pre-test t (96) = 2.424, P = .017 and post-test t (96) = 2.944, P = .004. Similarly, it was significantly varied between trainees from hospitals and Health centers at post-test t (96) = 2.403, P = .018. To sum up, the overall knowledge outcome of trainees significantly improved after the training. However, regarding knowledge outcome in relation to different variables, there was a significant mean knowledge score difference by sex both at pre- and post-test. Concerning the knowledge outcome in relation to facility type of the trainees, knowledge outcome significantly increased only those who came from hospitals at post-test. Therefore, to further enhance female trainees and those who come from Health Centers, a separate training session with extra support should be arranged by programmers.

Evaluation of helping babies breathe and essential care for every baby training in southern nations nationalities and people’s region, Ethiopia: applying a Kirkpatrick training evaluation model

Objective

The aim of this evaluation was to assess the effectiveness of helping baby breathe (HBB) and essential care for every baby (ECEB) training program that has been implemented in southern nations nationalities and people’s region (SNNPR), Ethiopia.

Result

The mean trainees’ satisfaction score was 32.88 (SD ± 2.68). The majority (93.88%) of the trainees scored ≥ mean. All trainees expressed that all parts of the training were important but the updated parts of the training were most useful to them. The mean knowledge score of trainees for HBB training increased from 64.42 (SD ± 17.43) before the training to 80.71 (SD ± 14.36) after the training. The increment was statistically significant at p < 0.001. For ECEB training, the mean knowledge score of the trainees was increased from 59.10 (SD ± 13.18) before the training to 73.73 (SD ± 14.17) after the training. The improvement was statistically significant at p < 0.001.

Implementation of the Helping Babies Breathe Training Program: A Systematic Review

CONTEXT

Helping Babies Breathe (HBB) is a well-established neonatal resuscitation program designed to reduce newborn mortality in low-resource settings.

OBJECTIVES

In this literature review, we aim to identify challenges, knowledge gaps, and successes associated with each stage of HBB programming.

DATA SOURCES

Databases used in the systematic search included Medline, POPLINE, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, African Index Medicus, Cochrane, and Index Medicus.

STUDY SELECTION

All articles related to HBB, in any language, were included. Article quality was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation framework.

DATA EXTRACTION

Data were extracted if related to HBB, including its implementation, acquisition and retention of HBB knowledge and skills, changes in provider behavior and clinical care, or the impact on newborn outcomes.

RESULTS

Ninety-four articles met inclusion criteria. Barriers to HBB implementation include staff turnover and limited time or focus on training and practice. Researchers of several studies found HBB cost-effective. Posttraining decline in knowledge and skills can be prevented with low-dose high-frequency refresher trainings, on-the-job practice, or similar interventions. Impact of HBB training on provider clinical practices varies. Although not universal, researchers in multiple studies have shown a significant association of decreased perinatal mortality with HBB implementation.

LIMITATIONS

In addition to not conducting a gray literature search, articles relating only to Essential Care for Every Baby or Essential Care for Small Babies were not included in this review.

CONCLUSIONS

Key challenges and requirements for success associated with each stage of HBB programming were identified. Despite challenges in obtaining neonatal mortality data, the program is widely believed to improve neonatal outcomes in resource-limited settings.