National neonatal resuscitation training program in Nigeria (2008-2012): a preliminary report

Scoping review of maternal and newborn health interventions and programmes in Nigeria

OBJECTIVE

To systematically scope and map research regarding interventions, programmes or strategies to improve maternal and newborn health (MNH) in Nigeria.

DESIGN

Scoping review.

DATA SOURCES AND ELIGIBILITY CRITERIA

Systematic searches were conducted from 1 June to 22 July 2020 in PubMed, Embase, Scopus, together with a search of the grey literature. Publications presenting interventions and programmes to improve maternal or newborn health or both in Nigeria were included.

DATA EXTRACTION AND ANALYSIS

The data extracted included source and year of publication, geographical setting, study design, target population(s), type of intervention/programme, reported outcomes and any reported facilitators or barriers. Data analysis involved descriptive numerical summaries and qualitative content analysis. We summarised the evidence using a framework combining WHO recommendations for MNH, the continuum of care and the social determinants of health frameworks to identify gaps where further research and action may be needed.

RESULTS

A total of 80 publications were included in this review. Most interventions (71%) were aligned with WHO recommendations, and half (n=40) targeted the pregnancy and childbirth stages of the continuum of care. Most of the programmes (n=74) examined the intermediate social determinants of maternal health related to health system factors within health facilities, with only a few interventions aimed at structural social determinants. An integrated approach to implementation and funding constraints were among factors reported as facilitators and barriers, respectively.

CONCLUSION

Using an integrated framework, we found most MNH interventions in Nigeria were aligned with the WHO recommendations and focused on the intermediate social determinants of health within health facilities. We determined a paucity of research on interventions targeting the structural social determinants and community-based approaches, and limited attention to pre-pregnancy interventions. To accelerate progress towards the sustainable development goal MNH targets, greater focus on implementing interventions and measuring context-specific challenges beyond the health facility is required.

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.

Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study

Background

Globally, approximately 9 million neonates develop perinatal asphyxia annually of which about 1.2 million die. Majority of the morbidity and mortality occur in Low and middle-income countries. However, little is known about the current trend in incidence, and the factors affecting mortality from hypoxic ischaemic encephalopathy (HIE), in Nigeria.

Objective

We assessed the trends in incidence and fatality rates and evaluated the predictors of mortality among babies admitted with HIE over five years at the Lagos University Teaching Hospital.

Methods

A temporal trend analysis and retrospective cohort study of HIE affected babies admitted to the neonatal unit of a Nigerian Teaching Hospital was conducted. The socio-demographic and clinical characteristics of the babies and their mothers were extracted from the neonatal unit records. Kaplan-Meir plots and Multivariable Cox proportional hazard ratio was used to evaluate the survival experienced using Stata version 16 (StataCorp USA) statistical software.

Results

The median age of the newborns at admission was 26.5 (10–53.5) hours and the male to female ratio was 2.1:1. About one-fifth (20.8%) and nearly half (47.8%) were admitted within 6 hours and 24 hours of life respectively, while majority (84%) of the infants were out-born. The prevalence and fatality rate of HIE in our study was 7.1% and 25.3% respectively. The annual incidence of HIE among the hospital admissions declined by 1.4% per annum while the annual fatality rate increased by 10.3% per annum from 2015 to 2019. About 15.7% died within 24 hours of admission. The hazard of death was related to the severity of HIE (p = 0.001), antenatal booking status of the mother (p = 0.01) and place of delivery (p = 0.03).

Conclusion

The case fatality rate of HIE is high and increasing at our centre and mainly driven by the pattern of admission of HIE cases among outborn babies. Thus, community level interventions including skilled birth attendants at delivery, newborn resuscitation trainings for healthcare personnel and capacity building for specialized care should be intensified to reduce the burden of HIE.

Basic neonatal resuscitation: retention of knowledge and skills of primary health care workers in Port Harcourt, Rivers State, Southern Nigeria

Introduction

birth attendants' retention of knowledge and skills of neonatal resuscitation post-training can prevent birth asphyxia by repeatedly applying neonatal resuscitation guidelines. This study assessed primary healthcare workers' retention of knowledge and skills of basic neonatal resuscitation.

Methods

in 28 primary health centres, 106 birth attendants had their knowledge and skills assessed following a one-day neonatal resuscitation training. The evaluation was before, immediately after training, at three months (a subset of participants) and six months. Paired t-tests were used to compare mean scores at two different evaluation times.

Results

the mean baseline knowledge and skills scores were 35.22% ± 12.90% and 21.40% ± 16.91% respectively. Immediately after training, it increased to 81.48% ± 7.05% and 87.40% ± 13.97% respectively (p=0.0001). At three months, it decreased to 55.37% ± 20.50% and 59.11% ± 25.55% respectively (p=0.0001), at six months it was 55.77% ± 14.28% and 60.38% ± 19.79% respectively (p=0.0001). Following immediate post-training at 6 months, knowledge and skills scores increased to 94.91 ± 7.28% and 96.02 ± 4.50% respectively (p=0.0001). No participant had adequate knowledge and one had adequate skills at baseline. The proportion of those with adequate knowledge and skills markedly increased immediate post-training but decreased remarkably at three-month and at six-month evaluations respectively. 99.1% had adequate knowledge and all had adequate skills immediate post-training at 6 months.

Conclusion

neonatal resuscitation training led to an improvement in knowledge and skills with suboptimal retention at three to six months post-training. Re-training improved knowledge and skills. We recommend that the retention of knowledge and skills could improve by retraining and mentoring at least 3-6 monthly.

Preparedness of primary health care workers and audit of primary health centres for newborn resuscitation in Port Harcourt, Rivers State, Southern Nigeria

Introduction:

Nigeria still has high newborn deaths and birth asphyxia remains a major cause. Birth attendants´ readiness to perform newborn resuscitation depends largely on their competence in basic resuscitation and availability of newborn resuscitation equipment to enable the various steps outlined in resuscitation guidelines to be applied quickly and appropriately. This study aimed to assess primary health care workers´ experience of neonatal resuscitation and audit primary health centres for availability of neonatal resuscitation equipment.

Methods:

this descriptive cross-sectional study surveyed 106 primary health care workers (22 doctors, 84 nurses) randomly selected from 28 Primary Health Centres to document their experiences in newborn resuscitation and appraise the centres for availability of newborn resuscitation equipment. Experience in newborn resuscitation was obtained using a semi-structured questionnaire and audit was with a Proforma following on-site facility visits. Data was analysed using SPSS v20 and displayed in tables and graphs.

Results:

all health care workers had resuscitated newborns but only 58(57.4%) had ever used a bag and mask, 53(50%) used stethoscopes and 19(17.9%) had resuscitation protocol in their facilities. Fifteen (53.6%) health centres had functional newborn-specific bag and masks, 11(39.3%) had suction machines and 5(25%) had empty oxygen cylinders.

Conclusion:

primary health care workers´ experience of newborn resuscitation is very limited and some primary health centres were grossly unequipped. Neonatal resuscitation training interventions and supplies of neonatal resuscitation equipment are urgently needed.

Evaluation of a Neonatal Resuscitation Curriculum in Liberia

Neonatal mortality in Africa is among the highest in the world. In Liberia, providers face significant challenges due to lack of resources, and providers in referral centers need to be prepared to appropriately provide neonatal resuscitation. A team of American Heart Association health care providers taught a two-day neonatal resuscitation curriculum designed for low-resource settings at a regional hospital in Liberia. The goal of this study was to evaluate if the curriculum improved knowledge and comfort in participation. The curriculum included simulations and was based on the Neonatal Resuscitation Protocol (NRP). Students learned newborn airway management, quality chest compression skills, and resuscitation interventions through lectures and manikin-based simulation sessions. Seventy-five participants were trained. There was a 63% increase in knowledge scores post training (p < 0.00001). Prior cardiopulmonary resuscitation (CPR) training, age, occupation, and pre-intervention test score did not have a significant effect on post-intervention knowledge test scores. The median provider comfort score improved from a 4 to 5 (p < 0.00001). Factors such as age, sex, prior NRP education, occupation, and post-intervention test scores did not have a significant effect on the post-intervention comfort level score. A modified NRP and manikin simulation-based curriculum may be an effective way of teaching health care providers in resource-limited settings. Training of providers in limited-resource settings could potentially help decrease neonatal mortality in Liberia. Modification of protocols is sometimes necessary and an important part of providing context-specific training. The results of this study have no direct relation to decreasing neonatal mortality until proven. A general resuscitation curriculum with modified NRP training may be effective, and further work should focus on the effect of such interventions on neonatal mortality rates in the region.

Evaluation of the cognitive effect of newborn resuscitation training on health-care workers in selected states in Northern Nigeria

BACKGROUND

Neonatal deaths contribute significantly to slower progress in under-5 mortality reduction. Lack of sufficiently trained birth assistants partly contributes to early neonatal deaths. Resuscitation training equips frontline health-care workers (HCWs) with requisite knowledge and skills to prevent birth asphyxia.

OBJECTIVE

The objective of this study was to evaluate the immediate impact of newborn resuscitation training on cognitive ability of HCWs.

MATERIALS AND METHODS

This is a descriptive observational study using pre- and posttraining scores obtained by HCWs who were participants in 1-day training on emergency newborn resuscitation. The Newborn Resuscitation Manual of the UK Resuscitation Council (2006) was used to train HCWs. The course included lectures, skill and scenario demonstrations using mannequins, and basic resuscitation equipment. Cognitive knowledge was evaluated using a pre- and post-training questionnaire. Participants' scores were collated, analyzed, and results were presented as tables, charts, and descriptive statistics with P < 0.05 considered statistically significant.

RESULTS

A total of 293 HCWs completed the course (81 doctors and 212 nurse/midwives), with variable improvements of mean posttraining marks over the pretraining scores. Resident doctors obtained significantly higher mean pre- and post-training marks with lower mean difference than senior doctors and medical officers. The junior nurses obtained significantly higher mean pretraining scores compared to the senior nursing cadre, while the intermediate nursing cadre obtained significantly higher mean posttraining scores compared to senior nurses.

CONCLUSION

Resuscitation training improved the knowledge of HCWs. Further evaluation could ascertain impacts on knowledge/skills' retention and neonatal survival. Preservice training and continuing education for frontline HCWs who conduct deliveries are recommended.

Heliotherapy for Neonatal Hyperbilirubinemia in Southwest, Nigeria: A Baseline Pre-Intervention Study

Background

A novel filtered-sunlight phototherapy (FSPT) device has been demonstrated to be safe and efficacious for treating infants with neonatal jaundice in resource-constrained tropical settings. We set out to provide baseline data for evaluating the clinical impact of this device in a referral pediatric hospital.

Methods

We reviewed the medical records of infants admitted for neonatal hyperbilirubinemia in an inner-city Children’s Hospital in Lagos, between January 2012 and December 2014 to determine the pattern, treatment and outcomes during the pre-intervention period. Factors associated with adverse outcomes were identified through multivariable logistic regression.

Results

Of the 5,229 neonatal admissions over the period, a total of 1,153 (22.1%) were admitted for neonatal hyperbilirubinemia. Complete records for 1,118 infants were available for analysis. The incidence of acute bilirubin encephalopathy (ABE) and exchange transfusion (ET) were 17.0% (95% CI: 14.9%–19.3%) and 31.5% (95% CI: 28.8%–34.3%) respectively. A total of 61 (5.5%, 95% CI: 4.3%–6.9%) of the jaundiced infants died. Weight on admission, peak total serum bilirubin (TSB), sepsis and exposure to hemolytic products were predictive of ABE, while age on admission, peak TSB, ABO incompatibility and ABE were predictive of ET. Rhesus incompatibility, asphyxia, exposure to hemolytic substances and ABE were associated with elevated mortality risk, while ET was a protective factor. Lack of routine irradiance monitoring and steady energy supply were frequent challenges for conventional blue-light phototherapy.

Conclusions

Severe hyperbilirubinemia is associated with high rates of ABE and ET in this setting, and remains a significant contributor to neonatal admissions and mortality. To be impactful, FSPT, complemented with improved diagnostic facilities, should effectively curtail jaundice-related adverse outcomes in this and comparable settings.