G295(P) Facilitators and barriers of continuous positive airway pressure use in newborn care in kenya (preliminary results). (12th March 2018) - Nabwera, HM
Abstract : Aim: To describe the operational aspects of continuous positive airway pressure (CPAP) use in newborn care in Kenya. Methods: An ongoing nationwide survey of all health facilities in Kenya that use CPAP in newborn care. The mixed method approach used includes a standard questionnaire to describe CPAP use; key informant interviews and focus group discussions with the health care providers, to explore facilitators and barriers to CPAP use in newborn care. Descriptive statistics are used to analyse the quantitative data. A thematic framework is used to analyse the qualitative data. Results: Twenty-two health facilities in Kenya provide CPAP in newborn care, but only 18 (82%) have agreed to participate in the survey. To date the survey has been conducted in 9 (50%) of these facilities, all of which are public county referral facilities that have been using CPAP in for ≤2 years. All of them use commercial bubble CPAP acquired predominantly through donor funding and have ≤3 machines per newborn care unit. Only 7/9 (78%) of the newborn care units had a doctor or nurse who had received training on the use of CPAP, and this was often on the job clinical training. The main indications for initiating CPAP were respiratory distress and suspected pneumonia. The main barriers to CPAP use in newborn care were inadequate training of health care providers on the use of CPAP, health care provider strikes and staff shortages, and inadequate support with management of equipment when donor support ended. The main facilitators were good leadership both at the unit and facility level that supported the sustainability of CPAP use in newborn care and peer support from carers whose newborns had survived following CPAP use. Conclusion: The scale-up of CPAP use in newborn care in Kenya is well accepted by health care providers, but there are significant challenges with the sustainability of this intervention. Going forward, implementation strategies need to ensure that all staff working in newborn care units are adequately trained to safely administer CPAP, and that the health facilities are empowered to maintain the CPAP machines or have ready access to this support.