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Bubble CPAP and oxygen for child pneumonia care in Malawi: a CPAP IMPACT time motion study.

ABSTRACT: BACKGROUND:In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial). METHODS:Eligible participants were 1-59?months old with WHO-defined severe pneumonia and HIV-infection, HIV-exposure, severe malnutrition, or hypoxemia and were randomized to either bCPAP or oxygen. We used time motion techniques to observe hospital care in four hour blocks during treatment initiation or follow up (maintenance). HCW mean time per patient at the bedside over the observation period was calculated by study arm. RESULTS:Overall, bCPAP required an average of 34.71?min per patient more than low-flow nasal oxygen to initiate (bCPAP, 118.18?min (standard deviation (SD) 42.73?min); oxygen, 83.47?min (SD, 20.18?min), p?

SUBMITTER: Sessions KL

PROVIDER: S-EPMC6668155 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Bubble CPAP and oxygen for child pneumonia care in Malawi: a CPAP IMPACT time motion study.

Sessions Kristen L KL Mvalo Tisungane T Kondowe Davie D Makonokaya Donnie D Hosseinipour Mina C MC Chalira Alfred A Lufesi Norman N Eckerle Michelle M Smith Andrew G AG McCollum Eric D ED

BMC health services research 20190731 1

<h4>Background</h4>In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial).<h4>Meth ...[more]

PMID: 31366394

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Project description:BACKGROUND:Preterm birth complications are the leading cause of neonatal deaths. Malawi has high rates of preterm birth, with 18.1 preterm births per 100 live births. More than 50% of preterm neonates develop respiratory distress which if left untreated, can lead to respiratory failure and death. Term and preterm neonates with respiratory distress can often be effectively managed with Continuous Positive Airway Pressure (CPAP) and this is considered an essential intervention for the management of preterm neonates by the World Health Organization. Bubble CPAP may represent a safe and cost-effective method for delivering CPAP in low-income settings. OBJECTIVE:The study explored the factors that influence the implementation of bubble CPAP among health care professionals in secondary and tertiary hospitals in Malawi. METHODS:This was a qualitative study conducted in three district hospitals and a tertiary hospital in southern Malawi. We conducted 46 in-depth interviews with nurses, clinicians and clinical supervisors, from June to August 2018. All data were digitally recorded, transcribed verbatim and thematically analyzed. RESULTS:Factors that influenced implementation of bubble CPAP occurred in an interconnected manner and included: inadequate healthcare provider training in preparation for use, rigid division of roles and responsibilities among providers, lack of effective communication among providers and between providers and newborn's caregivers, human resource constraints, and inadequate equipment and infrastructure. CONCLUSION:There are provider, caregiver and health system level factors that influence the implementation of bubble CPAP among neonates in Malawian health facilities. Ensuring adequate staffing in the nurseries, combined with ongoing training for providers, team cohesion, improved communication with caregivers, and improved hospital infrastructure would ensure optimal utilization of bubble CPAP and avoid inadvertent harm from inappropriate use.

Dataset Information

Bubble CPAP and oxygen for child pneumonia care in Malawi: a CPAP IMPACT time motion study.

Publications

Bubble CPAP and oxygen for child pneumonia care in Malawi: a CPAP IMPACT time motion study.

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