Abstract
Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation. To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings. A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted. 1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP. Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration.
Highlights
The World Health Organization has declared the reduction of neonatal mortality a global priority [1]
Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration
While reviews of all forms of Continuous positive airway pressure (CPAP) [12, 13] have described the efficacy of the treatment, there has been a specific focus on Bubble continuous positive airway pressure (bCPAP) therapies suggesting that bCPAP may be safe and effective in low and middle income countries (LMICs) [14,15,16]
Summary
The World Health Organization has declared the reduction of neonatal mortality a global priority [1]. While reviews of all forms of CPAP [12, 13] have described the efficacy of the treatment, there has been a specific focus on bCPAP therapies suggesting that bCPAP may be safe and effective in low and middle income countries (LMICs) [14,15,16] These reviews called for further research on effectiveness and sustainability of bCPAP therapy in lowresource settings [13,14,15,16]. A broader picture that considers qualitative factors is needed to understand how to create lasting sustainable uptake of CPAP To explore these factors the following research question was formulated: What are identified barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings? While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation
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