‘Sometimes you are forced to play God…’: a qualitative study of healthcare worker experiences of using continuous positive airway pressure in newborn care in Kenya

Nabwera, Helen, Wright, Jemma L, Patil, Manasi, Dickinson, Fiona ORCID: https://orcid.org/0000-0002-5298-9127, Godia, Pamela, Maua, Judith, Sammy, Mercy K, Naimoi, Bridget C, Warfa, Osman H, Dewez, Juan Emmanuel, Murila, Florence, Manu, Alexander ORCID: https://orcid.org/0000-0001-5230-6413, Smith, Helen and Mathai, Matthews ORCID: https://orcid.org/0000-0002-7352-9330 (2020) '‘Sometimes you are forced to play God…’: a qualitative study of healthcare worker experiences of using continuous positive airway pressure in newborn care in Kenya'. BMJ Open, Vol 10, Issue 8, e034668.

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Abstract

​Objective: To explore the experiences of using continuous positive airway pressure (CPAP) in newborn care among healthcare workers in Kenya, and to identify factors that would promote successful scale-up. ​Design and setting: A qualitative study using key informant interviews and focus group discussions, based at secondary and tertiary level hospitals in Kenya. ​Participants: Healthcare workers in the newborn units providing CPAP. ​Primary and secondary outcome measure: Facilitators and barriers of CPAP use in newborn care in Kenya. ​Results: 16 key informant interviews and 15 focus group discussions were conducted across 19 hospitals from September 2017 to February 2018. Main barriers reported were: (1) inadequate infrastructure to support the effective delivery of CPAP, (2) shortage of skilled staff rendering it difficult for the available staff to initiate or monitor infants on CPAP and (3) inadequate knowledge and training of staff that inhibited the safe care of infants on CPAP. Key facilitators reported were positive patient outcomes after CPAP use that increased staff confidence and partnership with caregivers in the management of newborns on CPAP. Healthcare workers in private/mission hospitals had more positive experiences of using CPAP in newborn care as the relevant support and infrastructure were available. ​Conclusion: CPAP use in newborn care is valued by healthcare workers in Kenya. However, we identified key challenges that threaten its safe use and sustainability. Further scale-up of CPAP in newborn care should ensure that staff members have ready access to optimal training on CPAP and that there are enough resources and infrastructure to support its use. Ethics: This study was approved through the appropriate ethics committees in Kenya and the UK (see in text) with written informed consent for each participant.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > W 21 Medicine as a profession. WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WB Practice of Medicine > WB 105 Emergency medicine. Medical emergencies WF Respiratory System > WF 100 General works WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjopen-2019-034668
SWORD Depositor:	JISC Pubrouter
Depositing User:	Stacy Murtagh
Date Deposited:	17 Aug 2020 11:11
Last Modified:	17 Aug 2020 11:11
URI:	https://archive.lstmed.ac.uk/id/eprint/15318

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