Health System Factors Influencing Practice of Neonatal Resuscitation among Nurses in Machakos Level 5 Hospital

Abstract

The first minute after birth is usually referred to as the golden minute, and the new born baby should be able to initiate spontaneous breathing, failure to which a condition called birth asphyxia ensues. Globally, approximately 5 per cent to10 per cent of newborns in facilities require resuscitation after delivery. In sub-Saharan Africa where over one third of all intrapartum related neonatal deaths occur, the rates of skilled attendance at birth are very low. In Kenya neonatal mortality remains at 22/100,000 live births, majority associated with poor resuscitation. This study sought to assess neonatal resuscitation practice among nurses in Machakos Level 5 Hospital, in Machakos County, Kenya. Specifically the study sought to assess health system factors that influence practice of neonatal resuscitation among nurses. The study adopted a descriptive cross-sectional study design. The study population included a sample of 201 nurses working in Machakos level 5 hospitals in Machakos County. Quantitative data was collected using semi-structured questionnaires from selected nurses through systematic random sampling at a predetermined interval of 2. Qualitative data was collected using key informant interview schedules with 6 selected Key Informants. Key informants were purposively selected for inclusion in the study. Descriptive statistics were analyzed using Statistical Package for Social Sciences (spss) version 24.0 with the aid of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Qualitative data was analyzed using thematic analysis and results triangulated with quantitative data as narrations. To test the association between study variables, Chi-Square tests done was at 95% confidence interval (p<0.05) were used. The study results revealed that 41 per cent of respondents fully practiced neonatal resuscitation. Health system factors that significantly influenced neonatal resuscitation included; availability of resuscitation equipment (p=0.001), place of keeping resuscitation equipment (p=0.021) and reference to guidelines (p=0.001). The study recommends increased rates of continuous medical education of nurses coupled with strict supervision to increase achievement rates of practicing neonatal resuscitation according to the guidelines. The Ministry of Health and Machakos County should create awareness to the policy makers on training methods to improve on the level of skill and knowledge on newborn resuscitation among nurses deployed in the country’s medical institutions thus reducing rates of neonatal mortality.