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Asferie WN, Kefale D, Kassaw A, Ayele AS, Nibret G, Tesfahun Y, Shimels Hailemeskel H, Demis S, Zeleke S, Aytenew TM. Health Professionals' knowledge and practice on basic life support and its predicting factors in Ethiopia: Systematic review and meta-analysis. PLoS One 2024; 19:e0297430. [PMID: 38593136 PMCID: PMC11003682 DOI: 10.1371/journal.pone.0297430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/04/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Basic Life Support (BLS) is a sequence of care provided to patients who are experiencing respiratory arrest, cardiac arrest, or airway obstruction. Its main purpose is to maintain the airway, breathing, and circulation through CPR. This review aimed to estimate the pooled prevalence of Health Professionals' knowledge and practice on basic life support in Ethiopia. METHOD Eligible primary studies were accessed from international database (PubMed, Google Scholar, Hinari databases) and grey literatures found in online repositories. The required data were extracted from those studies and exported to Stata 17 for analysis. A weighted inverse-variance random-effects model and Der Simonian-Laird estimation method were used to compute the overall pooled prevalence of Health Professional's knowledge, practice of basic life support and its predictors. Variations across the included studies were checked using forest plot, funnel plot, I2 statistics, and Egger's test. RESULT A total of 5,258 Health Professionals were included from 11 studies. The pooled prevalence of knowledge and practice outcomes on basic life support in Ethiopia were 47.6 (95% CI: 29.899, 65.300, I2: 99.21%) and 44.42 (95% CI: 16.42, 72.41, I2: 99.69) respectively. Educational status of the Professional's was significantly associated with knowledge outcome. Those who had degree and above were 1.9 times (AOR: 1.90 (1.24, 2.56)) more likely knowledgeable on basic life support than under degree. CONCLUSION The overall pooled estimates of Health Professionals knowledge and practice on basic life support was considerably low. The educational status of the Health Professionals was significantly associated with knowledge outcome. The Health Professionals and responsible stakeholders should focus on the basic life support at Health Institutions. The professionals should advance their knowledge and skill on basic life support for the patients.
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Affiliation(s)
- Worku Necho Asferie
- Department of pediatric and neonatal Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of pediatric and neonatal Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of pediatric and neonatal Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn Ayele
- Department of Midwifery, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret
- Department of Midwifery, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun
- Department of Emergency and Critical Care Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habitamu Shimels Hailemeskel
- Department of pediatric and neonatal Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of pediatric and neonatal Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shegaw Zeleke
- Department of Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye Aytenew
- Department of Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Mihretie GN, Liyeh TM, Ayele AD, Kassa BG, Belay HG, Aytenew TM, Sewuye DA, Birhane BM, Misk AD, Alemu BK. Knowledge and skills of newborn resuscitation among health care professionals in East Africa. A systematic review and meta-analysis. PLoS One 2024; 19:e0290737. [PMID: 38457446 PMCID: PMC10923462 DOI: 10.1371/journal.pone.0290737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/14/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Newborn resuscitation is a medical intervention to support the establishment of breathing and circulation in the immediate intrauterine life. It takes the lion's share in reducing neonatal mortality and impairments. Healthcare providers' knowledge and skills are the key determinants of the success of newborn resuscitation. Many primary studies have been conducted in various countries to examine the level of knowledge and skills of newborn resuscitation and associated factors among healthcare providers. However, these studies had great discrepancies and inconsistent results across East Africa. Hence, this review aimed to synthesize the pooled level of knowledge and skills of newborn resuscitation and associated factors among healthcare providers in East Africa. METHOD Studies were systematically searched from February 11, 2023, to March 10, 2023, using PubMed, Google Scholar, HINARI, and grey literature. The effect size measurement of knowledge and skill of health care newborn resuscitation was estimated using the Random Effect Model. The data were extracted by Excel and analyzed using Stata 17 software. The Cochran's Q test and I2 statistic were used to assess the heterogeneity of studies. The symmetry of the funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was done on the study years, sample sizes, and geographical location. Percentages and odds ratios (OR) with 95% CI were used to pool the effect measure. RESULTS In this systematic review and meta-analysis, a total of 1953 articles were retrieved from various databases and registers. Finally, 17 studies with 7655 participants were included. The overall levels of knowledge and skills of healthcare providers on newborn resuscitation were 58.74% (95% CI: 44.34%, 73.14%) and 46.20% (95% CI: 25.16%, 67.24%), respectively. Newborn resuscitation training (OR = 3.95, 95% CI: 2.82, 5.56) and the availability of newborn resuscitation guidelines (OR = 2.71, 95% CI: 1.90, 3.86) were factors significantly associated with knowledge of health care professionals on newborn resuscitation. Work experience (OR = 5.92, 95% CI, 2.10, 16.70), newborn resuscitation training (OR = 2.83, 95% CI, 1.8, 4.45), knowledge (OR = 3.05, 95% CI, 1.78, 5.30), and the availability of newborn resuscitation equipment (OR = 4.92, 95% CI, 2.80, 8.62) were determinant factors of skills of health care professionals on newborn resuscitation. CONCLUSION The knowledge and skills of healthcare providers on newborn resuscitation in East Africa were not adequate. Newborn resuscitation training and the availability of resuscitation guidelines were determinant factors of knowledge, whereas work experience, knowledge, and the availability of newborn resuscitation equipment and training were associated with the skills of healthcare providers in newborn resuscitation. Newborn resuscitation training, resuscitation guidelines and equipment availability, and work experience are recommended to improve healthcare providers' knowledge and skills.
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Affiliation(s)
- Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Alemu Degu Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Gebrehana Belay
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dagne Addisu Sewuye
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Agenesh Dereje Misk
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Daka DT, Wubneh CA, Alemu TG, Terefe B. Incidence and predictors of mortality among neonates admitted with perinatal asphyxia at west Oromia tertiary hospitals, Ethiopia, 2022. BMC Pediatr 2023; 23:475. [PMID: 37726683 PMCID: PMC10510233 DOI: 10.1186/s12887-023-04313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Perinatal asphyxia is one of the preventable and treatable causes of neonatal mortality. However, it is the fifth-largest cause of under-five mortality. Even with management advancements, it remains one of the key public health issues in underdeveloped countries, including Ethiopia. Comorbidities are also understated; therefore, adequate information regarding the incidence of death and its predictors is required. METHODS A four-year retrospective follow-up study was conducted from October 3 to November 2, 2022. From a total sample size, of 655, 616 data were collected by nurse through follow-up reviews charts using Kobo Toolbox software. The data was exported to STATA Version 14 for analysis. The Cox proportional hazard assumption was checked, and the model for the data was selected using Akaike Information Criteria. Finally, an adjusted hazard ratio with 95% CI was computed, and variables with a P-value < 0.05 in the multivariable analysis were taken as significant predictors of death. RESULT The overall incidence of mortality was 38.86/1000 (95% CI: 33.85-44.60). The median time of follow-up was 15 days (95% CI: 14-20). The proportion of deaths was 202 (32.79%, 95% CI: 29.18-36.61) among neonates with perinatal asphyxia. While the distance from health facility > 10 km is (AHR: 2.25; 95% CI: 1.60-3.17), direct oxygen (AHR: 1.83; 95% CI: 1.35-2.48), APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration) < 3 at the fifth minute (AHR: 2.63; 95% CI: 1.03-6.73), prolonged rupture of membrane (AHR: 1.41; 95% CI: 1.02-1.94), and stage III hypoxic ischemic encephalopathy (AHR: 2.02; 95% CI: 1.18-3.47) were predictors of mortality among neonates with perinatal asphyxia. CONCLUSION According to this study's findings, high neonatal mortality due to perinatal asphyxia requires proper intervention regarding membrane rupture, APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration), oxygen use, stage III hypoxic-ischemic encephalopathy, and residence distance.
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Affiliation(s)
- Dawit Tesfaye Daka
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Utomo MT, Sampurna MTA, Widyatama RA, Visuddho V, Angelo Albright I, Etika R, Angelika D, Handayani KD, Irzaldy A. Neonatal resuscitation: A cross-sectional study measuring the readiness of healthcare personnel. F1000Res 2023; 11:520. [PMID: 37476818 PMCID: PMC10354456 DOI: 10.12688/f1000research.109110.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 07/22/2023] Open
Abstract
Background: Optimal neonatal resuscitation requires knowledge and experience on the part of healthcare personnel. This study aims to assess the readiness of hospital healthcare personnel to perform neonatal resuscitation. Methods: This was an observational study conducted in May 2021 by distributing questionnaires to nurses, midwives, doctors, and residents to determine the level of knowledge and experience of performing neonatal resuscitation. Questionnaires were adapted from prior validated questionnaires by Jukkala AM and Henly SJ. We conducted the research in four types of hospitals A, B, C, and D, which are defined by the Regulation of the Minister of Health of the Republic of Indonesia. Type A hospitals have the most complete medical services, while type D hospitals have the least medical services. The comparative analysis between participants' characteristics and the knowledge or experience score was conducted. Results: A total of 123 and 70 participants were included in the knowledge and experience questionnaire analysis, respectively. There was a significant difference (p = 0.013) in knowledge of healthcare personnel between the type A hospital (median 15.00; Interquartile Range [IQR] 15.00-16.00) and type C hospital (median 14.50; IQR 12.25-15.75). In terms of experience, the healthcare personnel of type A (median 85.00; IQR 70.00-101.00) and type B (median 92.00; IQR 81.00-98.00) hospitals had significantly (p =0,026) higher experience scores than the type D (median 42.00; IQR 29.00-75.00) hospital, but we did not find a significant difference between other type of hospitals. Conclusions: In this study, we found that the healthcare personnel from type A and type B hospitals are more experienced than those from type D hospitals in performing neonatal resuscitation. We suggest that a type D hospital should refer the neonate to a type A or type B hospital if there is sufficient time in cases of risk at need for resuscitation.
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Affiliation(s)
- Martono Tri Utomo
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, 60132, Indonesia
| | - Mahendra Tri Arif Sampurna
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, 60132, Indonesia
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Airlangga Teaching Hospital, Surabaya, East Java, 60115, Indonesia
| | | | - Visuddho Visuddho
- Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60132, Indonesia
| | - Ivan Angelo Albright
- Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60132, Indonesia
| | - Risa Etika
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, 60132, Indonesia
| | - Dina Angelika
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, 60132, Indonesia
| | - Kartika Darma Handayani
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, 60132, Indonesia
| | - Abyan Irzaldy
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, South Holland, Postbus 2040, 3000 CA, Indonesia
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Gidam NN, Abdelgair WI. Quasi-experimental quantitative study of training programme for nurses and midwives regarding provision of neonatal resuscitation in selected governmental hospital, (Sudan), 2018. Nurs Open 2022; 10:790-795. [PMID: 36074779 PMCID: PMC9834532 DOI: 10.1002/nop2.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS To measure the effectiveness of educational programmes for nurses regarding knowledge and practice of advanced resuscitation for newborn infants. DESIGN This is a quasi-experimental study in (Sudan, White Nile state), to evaluate the effectiveness of designed guidelines regarding advanced neonatal resuscitation for midwives during the period November 2020-January 2021. METHODS Data were collected using two tools: semi-structured questionnaire and checklist. The number of the respondents to the questionnaire is 75 nurses. Statistical analyses were conducted using SPSS (version 22). Data were expressed as percentages. The results show that the level of knowledge is improved significantly after training programme interventions, with safe practice reaching (98.70%) compared with a pre-test percentage of (11.5%). This indicates a steep rise in safe practice after the simulation section, a sharp decrease in unsafe practice after the practical section, followed by subsequent decrease in neonatal mortality rate. This paper has been guided by (STROBE, cohort study) checklist. RESULTS The study concluded that the majority of nurses and midwives have some knowledge regarding advanced neonatal resuscitation but still, there is a practice gap because of a shortage of facilities and lack of training, However, training programmes do add value on knowledge and practice for nurses and eventually decrease neonatal mortality rate.
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Affiliation(s)
| | - Widad Ibrahim Abdelgair
- Nursing Department, College of Applied Medical Sciences(ALTAIF) UniversityAltaif CitySaudi Arabia
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Usman F, Tsiga-Ahmed FI, Abdulsalam M, Farouk ZL, Jibir BW, Aliyu MH. Facility and care provider emergency preparedness for neonatal resuscitation in Kano, Nigeria. PLoS One 2022; 17:e0262446. [PMID: 34995340 PMCID: PMC8741031 DOI: 10.1371/journal.pone.0262446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Fatima Usman
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
- * E-mail:
| | - Fatimah I. Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano Nigeria
| | - Mohammed Abdulsalam
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Zubaida L. Farouk
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Binta W. Jibir
- Department of Pediatrics, Hasiya Bayero Pediatrics Hospital, Kano, Nigeria
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Centre, Nashville, Tennessee, United States of America
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Liaqat M, Hussain M, Afzal M, Altaf M, Khan S, Gilani SA, Liaqat I. Efficacy of pedagogical framework in neonatal resuscitation skill learning in a resource-limited setting: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:436. [PMID: 34407810 PMCID: PMC8371841 DOI: 10.1186/s12909-021-02846-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The educational efficacy in neonatal resuscitation relies on the subject and teaching strategies. Therefore, it is imperative to test diverse educational methods if they are more instructive to engage students in active learning and practicing knowledge. Hence, the present study aims to investigate the efficacy of a pedagogical framework in neonatal resuscitation skill learning among nursing students in a resource-limited setting. METHODS A single-blind randomized controlled trial was conducted between October 2020 to March 2021. Sixty nursing students in the 3rd and 4th year of professional training were randomly allocated to the pedagogy and the traditional group. The pedagogy group learned via 6-step LSPPDM (Learn, See, Practice, Prove, Do, Maintain) pedagogy including lectures, video, clinical observation, skill sessions under supervision, and self-directed practice. The traditional group learned through 2-step (Learn, Practice) method that included lectures and skill sessions under supervision. The outcomes measured included technical and non-technical skills in neonatal resuscitation. The technical skill deals with steps such as stimulation, ventilation, oxygenation, intubation, chest compression, medications, and reporting. Non-technical skills refer to teamwork skills that focus on the interaction between leader and helper. Both skills were measured through previously published validated tools two times before and after the intervention by blinded assessors in a simulated delivery room. RESULTS Overall, the skill was significantly improved in both groups after intervention. Yet, the results showed that the mean difference of technical skill score in the pedagogy group (24.3 ± 3.5) was significantly higher (p < 0.001) compared to the traditional group (16.2 ± 2.4). Likewise, the mean difference of non-technical skill score in the pedagogy (36.9 ± 1.9) was highly significant (p < 0.001) compared to the traditional group (31.2 ± 1.7). CONCLUSIONS The LSPPDM pedagogy was found more effective in enhancing technical and non-technical skills in neonatal resuscitation compared to the traditional method. The results of this study support the efficacy of the 6-step LSPPDM pedagogy in the education of nursing students regarding neonatal resuscitation in a resource-limited setting. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov ( NCT04748341 ).
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Affiliation(s)
- Mishal Liaqat
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan.
| | - Muhammad Hussain
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Muhammad Afzal
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Maryam Altaf
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Sadia Khan
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Iram Liaqat
- Department of Zoology, The Government College University, Lahore, Pakistan
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Tadesse M, Hally S, Rent S, Platt PL, Eusterbrock T, Gezahegn W, Kifle T, Kukora S, Pollack LD. Effect of a Low-Dose/High-Frequency Training in Introducing a Nurse-Led Neonatal Advanced Life Support Service in a Referral Hospital in Ethiopia. Front Pediatr 2021; 9:777978. [PMID: 34900877 PMCID: PMC8656416 DOI: 10.3389/fped.2021.777978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11-31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia. Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with normal axillary temperature (36.5-37.5°C) within the first hour of life were evaluated. Data were analyzed using the χ2 test, and p-values < 0.05 were considered statistically significant. Following the implementation of the NALS service, semi-structured interviews with key stakeholders were conducted to evaluate their perception of the service; the interviews were recorded, transcribed, and coded for thematic analysis. Results: There was a decrease in the proportion of neonates who died in the LDU (from 3.5 to 1%) during the immediate post-implementation period, followed by a sustained decrease over the study period (p < 0.001). The change in the NICU admission rate (from 22.8 to 21.2%) was insignificant (p = 0.6) during this initial period. However, this was followed by a significant sustained decrease (7.8% in group E and 9.8% in group F, p < 0.001). The proportion of newborns with normal axillary temperature improved from 46.2% during the initial post-implementation period to 87.8% (p < 0.01); this proportion further increased to 99.8%. The program was perceived positively by NALS team members, NICU care providers, and hospital administrators. Conclusion: In resource-limited settings, LDHF training for neonatal resuscitation improves the neonatal resuscitation skills and management of delivery room attendants.
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Affiliation(s)
- Misrak Tadesse
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Suzanne Hally
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States.,School of Nursing, Endicott College, Boston, MA, United States
| | - Sharla Rent
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Phillip L Platt
- Wax & Gold Inc., Amarillo, TX, United States.,Pediatrix Medical Group, Department of Neonatology, Baptist St Anthony's Hospital, Amarillo, TX, United States
| | - Thomas Eusterbrock
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
| | | | - Tsinat Kifle
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie Kukora
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Louis D Pollack
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
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