Abstract
BackgroundWhile Malawi has achieved success in reducing overall under-five mortality, reduction of neonatal mortality remains a persistent challenge. There has, therefore, been a push to strengthen the capacity for quality newborn care at district hospitals through the implementation of innovative neonatal technologies such as bubble continuous positive airway pressure (CPAP). This study investigates tertiary- versus secondary-level hospital differences in capacities for bubble CPAP use and implications for implementation policies.MethodsA secondary analysis of interviews was conducted with 46 health workers at one tertiary hospital and three secondary hospitals in rural Southern Malawi. Grounded theory was utilized to explore the emerging themes according to health worker cadres (nurse, clinician, district health management) and facility level (tertiary- and secondary-level facilities), which were managed using NVivo 12 (QSR International, Melbourne, Australia).ResultsWe identified frequent CPAP use and the availability of neonatal nurses, physicians, and reliable electricity as facilitators for CPAP use at the tertiary hospital. Barriers at the tertiary hospital included initiation eligibility disagreements between clinicians and nurses and insufficient availability of the CPAP machines. At secondary-level hospitals, the use was supported by decision-making and initiation by nurses, involving caretakers to assist in monitoring and reliable availability of CPAP machines. Bubble CPAP was hindered by unreliable electricity, staffing shortages and rotation policies, and poor systems of accountability.ConclusionWhile this study looked at the implementation of bubble CPAP in Malawi, the findings may be applicable for scaling up other novel neonatal technologies in low-resource settings. Implementation policies must consider staffing and management structures at different health services levels for effective scale-up.
Highlights
While Malawi has achieved success in reducing overall under-five mortality, reduction of neonatal mortality remains a persistent challenge
While this study looked at the implementation of bubble continuous positive airway pressure (CPAP) in Malawi, the findings may be applicable for scaling up other novel neonatal technologies in low-resource settings
Effective implementation of neonatal technologies to strengthen newborn care in low-resource settings is key to improving quality of care and reducing newborn deaths
Summary
While Malawi has achieved success in reducing overall under-five mortality, reduction of neonatal mortality remains a persistent challenge. There has, been a push to strengthen the capacity for quality newborn care at district hospitals through the implementation of innovative neonatal technologies such as bubble continuous positive airway pressure (CPAP). This study investigates tertiary- versus secondary-level hospital differences in capacities for bubble CPAP use and implications for implementation policies. Malawi has achieved a number of successes in maternal and child health including meeting the Millennium Development Goal of reducing under-five child mortality rates [1] and an increase in the proportion of facility births from 55% in 2010 to 91% in 2016 [2]. A Malawian study found that health facilities with poor quality obstetric and newborn care were concentrated in rural areas that were associated with 2.3% higher neonatal mortality rates [5]. To reduce the unacceptable burden of newborn deaths in Malawi, there has been a push to improve the quality of newborn care at district levels. Implementation factors and constraints in district hospitals may compromise the benefits of bubble CPAP
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