Abstract
BackgroundSevere respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about caregivers’ engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi.MethodsThis was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP.ResultsEmerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP.ConclusionsSince caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP.
Highlights
Severe respiratory distress is a leading cause of mortality among neonates in Malawi
The project is a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative funded by the Canadian International Development Research Centre (IDRC), Global Affairs Canada (GAC) and the Canadian Institutes for Health Research (CIHR)
The tertiary hospital has a Neonatal Care Unit as well as several High Dependency Units (HDU) and wards where bubble continuous positive airway pressure (CPAP) is administered to infants and children
Summary
Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Sub-Saharan Africa (SSA) alone contributes 39% of all global neonatal death and includes eight of the ten countries with the worst indicators globally [3, 4]. The goal towards elimination of preventable infant mortality is reaffirmed in the Sustainable Development Goal 3.2 and aims at reducing neonatal mortality to 12 per 1000 live births by 2030 [5]. Malawi achieved the Millennium Development Goal for reducing mortality rates of children under five by 73% between 1990 and 2015, progress on reducing neonatal deaths has been much slower [6]. By 2015, the main causes of neonatal deaths in the country were prematurity (33%), birth asphyxia and trauma (25.8%) and sepsis (18.6%) [4]. At 18.1%, Malawi registers as one of the highest preterm birth rates globally [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
