Exploring factors influencing practice of neonatal resuscitation with bag and mask in Ethiopia: Analysis from 2016 national emergency obstetric and newborn care survey

Journal of Multidisciplinary Healthcare, Volume 13, Year 2020

Interpretation

Background: Globally, more than 7 million children die under the age of five and the highest proportion of death is during the first 28 days of life. For babies who do not breathe at birth, neonatal resuscitation is critical in reducing intra-partum related neonatal deaths by 30%. Yet, there is a dearth of studies on the provision of neonatal resuscitation in Ethiopia. So, this study aimed to assess health facilities provision of neonatal resuscitation with bag and mask and its factors among asphyxiated newborns. Materials and Methods: Data used were from the Ethiopian 2016 Emergency Obstetric Newborn Care survey, conducted in 3,804 health facilities providing maternal and newborn health services. The analysis included neonatal resuscitation with bag and mask in the previous 3 months before the survey. Descriptive statistics, simple and multivariable regression analyses were performed using SPSS-21 version. Results: The analysis findings show that 72.2% of the health facilities were providing neonatal resuscitation with bag and mask. The result showed that hospitals (adjusted odds ratio (AOR): 3.90; 95% confidence interval (CI) [2.05, 7.49]), health-care providers not trained in neonatal resuscitation (AOR: 0.64; 95% CI [0.42, 0.99]) and availability of essential equipment (AOR: 1.32; 95% CI [1.15, 1.51]) were more likely to practice neonatal resuscitation. Conclusion: Overall practice of health facilities on neonatal resuscitation with bag and mask was at 72.2%. Type of facility, providers trained in neonatal resuscitation and availability of essential equipments were independently affecting the practice of neonatal resuscitation. Incorporating competency-based training, refresher training, and clinical mentorship will improve the practice. This was a secondary analysis of the data collected by the 2016 Ethiopian Emergency Obstetrics and Newborn care (EmONC) survey. The survey was a national cross-sectional census of health facilities, both public and private, that provided maternal and newborn health services. A total of 3,804 eligible public hospitals (referral, general, primary), health centers and all eligible private (for-profit and not-for-profit) facilities (hospitals, MCH Specialty Centers, MCH Specialty Clinics, and Higher Clinics) of all nine regions were included in the study. Practice of neonatal resuscitation with bag and mask in the 3 months before the survey was assessed.14 From the eligible health facilities one health professional working in the maternity ward ( a medical doctor, a health officer, a midwife or a nurse) was interviewed and asked whether newborn resuscitation with bag and mask had been performed in the last 3 months. The outcome variable was provision of neonatal resuscitation with bag and mask in all health facilities and health-care providers’ characteristics and health facility characteristics were independent factors. The data were analyzed using SPSS version 21. Descriptive characteristics of the participants were tabulated using frequencies, percentage, mean and standard deviation after normality was checked with Shapiro–Wilk test. Forward Likelihood Ratio multivariable logistic regression was conducted for those independent variables with p-value <0.25 at bi-variable regression analysis. Finally, variables with a p-value <0.05 in the multivariable analysis were considered to pronounce an independent association between covariates and the practice of neonatal resuscitation. Model assumption fulfillment and multi-collinearity test were done prior to multivariate logistic regression. The final logistic model goodness of fit was assessed using the Hosmer-Lemeshow goodness of fit test and an omnibus test of model coefficients. The result shows the model is fit. The primary researchers of the 2016 Ethiopia EmONC survey obtained ethical clearance from Ethiopian Public Health Institute and letter of permission from FMOH, and there was no need of ethical clearance for this secondary analysis. However, permission to access the data was obtained from FMOH of Ethiopia.

AI Digest

Study Justification:

– The study aimed to assess the provision of neonatal resuscitation with bag and mask in Ethiopia, as there is a lack of research on this topic in the country.
– Neonatal resuscitation is crucial in reducing neonatal deaths, especially for babies who do not breathe at birth.
– The study aimed to identify factors influencing the practice of neonatal resuscitation and provide insights for improving the provision of this life-saving intervention.

Highlights:

– 72.2% of health facilities in Ethiopia were found to provide neonatal resuscitation with bag and mask.
– Hospitals were more likely to practice neonatal resuscitation compared to other types of facilities.
– Health-care providers who were not trained in neonatal resuscitation were less likely to perform it.
– The availability of essential equipment was positively associated with the practice of neonatal resuscitation.

Recommendations:

– Incorporate competency-based training, refresher training, and clinical mentorship to improve the practice of neonatal resuscitation.
– Ensure that all health-care providers involved in maternal and newborn care receive training in neonatal resuscitation.
– Improve the availability of essential equipment for neonatal resuscitation in health facilities.

Key Role Players:

– Ministry of Health: Responsible for policy development, coordination, and implementation of interventions related to neonatal resuscitation.
– Health Facility Managers: Ensure the availability of trained staff and essential equipment for neonatal resuscitation.
– Health-care Providers: Receive training and provide neonatal resuscitation services.
– Professional Associations and Training Institutions: Provide training programs and support continuous professional development.

Cost Items for Planning Recommendations:

– Training Programs: Budget for developing and implementing competency-based training, refresher training, and clinical mentorship programs.
– Equipment Procurement: Allocate funds for the purchase and maintenance of essential equipment for neonatal resuscitation.
– Monitoring and Evaluation: Include resources for monitoring the implementation and impact of the recommendations.
– Capacity Building: Allocate funds for strengthening the capacity of health facilities and providers to deliver quality neonatal resuscitation services.
Please note that the provided cost items are general suggestions and may vary depending on the specific context and resources available in Ethiopia.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it is based on a secondary analysis of data collected from a national cross-sectional census of health facilities in Ethiopia. The study provides descriptive statistics and regression analyses to assess the factors influencing the practice of neonatal resuscitation with bag and mask. The sample size is large (3,804 health facilities) and the analysis includes both simple and multivariable regression. However, the study design is cross-sectional, which limits the ability to establish causality. To improve the strength of the evidence, future research could consider a longitudinal design to assess the impact of interventions on neonatal resuscitation practices. Additionally, conducting qualitative research to explore the barriers and facilitators of neonatal resuscitation in Ethiopia would provide a more comprehensive understanding of the topic.

Abstract

This was a secondary analysis of the data collected by the 2016 Ethiopian Emergency Obstetrics and Newborn care (EmONC) survey. The survey was a national cross-sectional census of health facilities, both public and private, that provided maternal and newborn health services. A total of 3,804 eligible public hospitals (referral, general, primary), health centers and all eligible private (for-profit and not-for-profit) facilities (hospitals, MCH Specialty Centers, MCH Specialty Clinics, and Higher Clinics) of all nine regions were included in the study. Practice of neonatal resuscitation with bag and mask in the 3 months before the survey was assessed.14 From the eligible health facilities one health professional working in the maternity ward ( a medical doctor, a health officer, a midwife or a nurse) was interviewed and asked whether newborn resuscitation with bag and mask had been performed in the last 3 months. The outcome variable was provision of neonatal resuscitation with bag and mask in all health facilities and health-care providers’ characteristics and health facility characteristics were independent factors. The data were analyzed using SPSS version 21. Descriptive characteristics of the participants were tabulated using frequencies, percentage, mean and standard deviation after normality was checked with Shapiro–Wilk test. Forward Likelihood Ratio multivariable logistic regression was conducted for those independent variables with p-value <0.25 at bi-variable regression analysis. Finally, variables with a p-value <0.05 in the multivariable analysis were considered to pronounce an independent association between covariates and the practice of neonatal resuscitation. Model assumption fulfillment and multi-collinearity test were done prior to multivariate logistic regression. The final logistic model goodness of fit was assessed using the Hosmer-Lemeshow goodness of fit test and an omnibus test of model coefficients. The result shows the model is fit. The primary researchers of the 2016 Ethiopia EmONC survey obtained ethical clearance from Ethiopian Public Health Institute and letter of permission from FMOH, and there was no need of ethical clearance for this secondary analysis. However, permission to access the data was obtained from FMOH of Ethiopia.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health:

1. Competency-based training: Incorporating competency-based training programs for healthcare providers in neonatal resuscitation with bag and mask can enhance their skills and knowledge in providing effective resuscitation to asphyxiated newborns.

2. Refresher training: Regular refresher training sessions can be organized to ensure that healthcare providers stay updated with the latest techniques and guidelines in neonatal resuscitation. This can help improve the quality of care provided to newborns in need of resuscitation.

3. Clinical mentorship: Implementing a clinical mentorship program can provide healthcare providers with ongoing support and guidance in neonatal resuscitation. Experienced mentors can help identify areas for improvement and provide personalized training to enhance skills and confidence.

4. Strengthening infrastructure: Ensuring the availability of essential equipment, such as bag and mask for neonatal resuscitation, in all health facilities is crucial. Investing in the procurement and maintenance of these equipment can improve the readiness of healthcare facilities to provide timely and effective resuscitation.

5. Policy and guideline development: Developing comprehensive policies and guidelines specifically focused on neonatal resuscitation can provide a standardized approach across all healthcare facilities. This can help ensure that best practices are followed and improve the overall quality of care provided.

6. Data-driven decision making: Regular monitoring and evaluation of neonatal resuscitation practices can help identify gaps and areas for improvement. Collecting and analyzing data on the provision of neonatal resuscitation can inform decision-making processes and guide targeted interventions.

It is important to note that these recommendations are based on the specific context and findings of the study mentioned. Further research and contextual analysis may be required to tailor these recommendations to specific settings and populations.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health would be to incorporate competency-based training, refresher training, and clinical mentorship for health-care providers in neonatal resuscitation with bag and mask. This recommendation is based on the findings that health-care providers who were not trained in neonatal resuscitation were less likely to practice it. By providing training and mentorship, health-care providers can enhance their skills and knowledge in neonatal resuscitation, leading to improved access to this life-saving intervention. Additionally, ensuring the availability of essential equipment is also important, as it was found to positively impact the practice of neonatal resuscitation. By addressing these factors, health facilities can enhance their provision of neonatal resuscitation and contribute to reducing neonatal deaths in Ethiopia.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Increase training in neonatal resuscitation: To improve the practice of neonatal resuscitation with bag and mask, it is important to ensure that healthcare providers receive adequate training in this area. Competency-based training, refresher courses, and clinical mentorship programs can be implemented to enhance the skills and knowledge of healthcare professionals.

2. Improve availability of essential equipment: The study found that the availability of essential equipment was positively associated with the practice of neonatal resuscitation. Therefore, efforts should be made to ensure that health facilities have the necessary equipment, such as bag and mask, to perform neonatal resuscitation effectively.

3. Strengthen referral systems: Hospitals were more likely to practice neonatal resuscitation compared to other types of health facilities. Strengthening referral systems and ensuring that asphyxiated newborns are promptly transferred to hospitals with the capacity to provide neonatal resuscitation can improve access to this life-saving intervention.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the target population: Identify the specific population or region where the recommendations will be implemented. This could be a specific district, province, or the entire country.

2. Collect baseline data: Gather data on the current practice of neonatal resuscitation, availability of essential equipment, and healthcare provider training in the target population. This can be done through surveys, interviews, or analysis of existing data.

3. Introduce the recommendations: Implement the recommended interventions, such as training programs for healthcare providers, improving the availability of essential equipment, and strengthening referral systems.

4. Monitor and evaluate: Continuously monitor the implementation of the recommendations and collect data on the impact. This can include tracking the number of healthcare providers trained, assessing the availability of essential equipment in health facilities, and measuring the practice of neonatal resuscitation.

5. Analyze the data: Use statistical analysis software, such as SPSS, to analyze the collected data. Conduct descriptive statistics to summarize the findings and perform regression analysis to assess the association between the implemented interventions and the practice of neonatal resuscitation.

6. Assess the impact: Evaluate the impact of the recommendations by comparing the post-intervention data with the baseline data. Calculate the changes in the practice of neonatal resuscitation, availability of essential equipment, and healthcare provider training.

7. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the implemented interventions in improving access to maternal health. Identify any challenges or barriers encountered during the implementation process and make recommendations for further improvement.

It is important to note that this is a general methodology and the specific details may vary depending on the context and resources available.

Authors & Co-Authors

Statistics:

Citations: 2

Authors: 4

Identifiers:

DOI: 10.2147/JMDH.S246347

Research Areas:

Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study

Study Approach:

Quantitative