Abstract
BackgroundBubble continuous positive airway pressure (CPAP) has been shown to be effective in supporting breathing in newborns with respiratory distress. The factors that influence implementation in resource-constrained settings remain unclear. The objective of this review is to evaluate the barriers and facilitators of CPAP implementation for newborn care at sub-Saharan African health facilities and how different facility levels and types of bubble CPAP systems may impact utilization.MethodsA systematic search (database inception to July 2019) was performed on MEDLINE Ovid, EMBASE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), the WHO Regional Database for Africa, African Index Medicus (AIM), African Journals Online, grey literature and the references of relevant articles. Studies that met the inclusion criteria (primary research, bubble CPAP implementation with neonates ≤ 28 days old at a health facility in sub-Saharan Africa) were included in the review and assessed with National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) quality assessment tools. The review protocol was published to PROSPERO (CRD42018116082).ResultsSeventeen studies were included in the review. Reliable availability of equipment, effectively informing and engaging caregivers and staffing shortages were frequently mentioned barriers to the implementation of bubble CPAP. Understaffed neonatal units and high turnover of nurses and doctors compromised effective training. Provider-to-provider clinical mentorship models as well as affordability and cost-effectiveness of innovative bubble CPAP systems were identified as frequently mentioned facilitators of implementation.ConclusionsWith a strong recommendation by the World Health Organization for its use with premature infants with respiratory distress, it is important to understand the barriers and facilitators that can inform the implementation of bubble CPAP. More research is needed into health system factors that can support or impede the use of this potentially promising intervention.
Highlights
There have been significant declines in infant mortality but rates of neonatal mortality are declining at a slower pace than among older infants and children [1]
Among newborns in sub-Saharan Africa, one in every 36 neonates die within the first month, a staggering inequality compared to one in 333 in high-income countries (HICs) [3]
With an estimated average pre-term birth rate at 12.3% across the sub-Saharan Africa region (12.3%), there is a need to effectively address accompanying complications in order to reduce the burden of neonatal deaths [1, 4]
Summary
There have been significant declines in infant mortality but rates of neonatal mortality are declining at a slower pace than among older infants and children [1]. Preterm birth complications are a leading cause of neonatal death [1] and a review found that nine of the 11 countries globally with estimated preterm birth rates of 15% or more were in subSaharan Africa [4]. With an estimated average pre-term birth rate at 12.3% across the sub-Saharan Africa region (12.3%), there is a need to effectively address accompanying complications in order to reduce the burden of neonatal deaths [1, 4]. The objective of this review is to evaluate the barriers and facilitators of CPAP implementation for newborn care at sub-Saharan African health facilities and how different facility levels and types of bubble CPAP systems may impact utilization
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