|Year : 2017 | Volume
| Issue : 2 | Page : 117-120
Neonatal resuscitation training and equipment in private health institutions in Kano metropolis
Adamu M Sarki
Department of Anaesthesiology and Intensive Care, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||5-Oct-2017|
Adamu M Sarki
Department of Anaesthesiology and Intensive Care, Bayero University Kano/Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Over 200,000 babies die yearly in Nigeria, of which about 26% is due to birth asphyxia. Effective neonatal resuscitation (NR) using basic equipment is capable of preventing up to 30% of deaths associated with perinatal asphyxia. However, NR is only effective where caregivers have sufficient knowledge and required skills. The frequent industrial actions by health workers in the public sector have brought to the fore the importance of private health facilities in healthcare delivery. Thus, there is a need to assess training of health workers and availability of basic equipment in private health institutions in Kano. Aim: To assess availability of trained providers on NR and resuscitation equipment in private health facilities in Kano. Materials and Methods: This is a cross sectional survey of 85 conveniently sampled private institutions that provide obstetric care as part of their services in Kano metropolis. A semi-structured self-administered questionnaire was used to collect data from each facility. Results: Seventy eight filled questionnaires were retrieved and analyzed. There were 25 specialist clinics, 44 general practice facilities, and nine maternity homes/primary healthcare (PHC). Only 29 (37.2%) of the facilities have caregivers trained on NR in attendance during normal deliveries. Thirty four (43.5%) facilities have written protocol on NR. Only two (22.2%) of the maternity homes/PHC have functional ambu bags; the corresponding figures for specialist and general practice clinics are 16 (64%) and 24 (54.5%) respectively. Conclusion: There is insufficient number of trained personnel on newborn resuscitation, and low availability of newborn resuscitation equipment in private health institutions in Kano metropolis.
Keywords: Birth asphyxia, neonatal resuscitation, resuscitation equipment
|How to cite this article:|
Sarki AM. Neonatal resuscitation training and equipment in private health institutions in Kano metropolis. Niger J Basic Clin Sci 2017;14:117-20
|How to cite this URL:|
Sarki AM. Neonatal resuscitation training and equipment in private health institutions in Kano metropolis. Niger J Basic Clin Sci [serial online] 2017 [cited 2020 Aug 4];14:117-20. Available from: http://www.njbcs.net/text.asp?2017/14/2/117/216056
| Introduction|| |
Every year, over 136 million babies are delivered worldwide, and it is estimated that 5–10% of these babies will require some form of assistance to initiate and/or sustain spontaneous breathing at birth. While majority of these babies with primary apnea will respond to simple stimulation through drying and rubbing, fewer numbers will require basic resuscitation using bag and mask to overcome their apnea. Less than 1% will actually require more advanced measures such as endotracheal intubation, chest compressions, and medications for survival.
In Nigeria, an estimated 255,500 newborns die annually, making the country's neonatal mortality rate the highest in Africa. Birth asphyxia, defined as the inability of a newborn to initiate and/or sustain spontaneous breath is estimated to be responsible for 26% of neonatal deaths in Nigeria.
Neonatal resuscitation (NR) is defined as the set of interventions at the time of birth to support the establishment of breathing and circulation. It has been estimated by researchers that training providers on NR in health facilities may prevent up to 30% of deaths of full-term babies with intrapartum-related events. NR skill is thus an important attribute of any healthcare personnel involved in the delivery of newborns. It is therefore pertinent to deduce that presence of health personnel skilled in NR has potentials of reducing neonatal mortalities attributable to birth asphyxia.
In Nigeria, prior to 2008 when the Paediatric Association of Nigeria (PAN) began training doctors and nurses/midwives on NR in pre-conference workshops during their annual conference, there was no coordinated National Training Programme on NR. Furthermore, the participants during these pre-conference training sessions are largely personnel from public healthcare institutions.
Private healthcare facilities are important components of the overall healthcare delivery system in Nigeria. Lamina and colleagues in a study in south-western Nigeria discovered that only 47.6% of pregnant women who attended antenatal care in their center (a tertiary care public center) subsequently delivered there; and a follow-up cross-sectional survey revealed that up to 58.3% of expectant mothers prefer delivery in a private health facility as against only 28% who prefer delivery in the public health facility. Another study in south-eastern Nigeria revealed a higher figure (72.8%) for the preference of delivery in private clinics. These findings underscore the importance of private health facilities in the delivery of healthcare.
This survey was designed to assess the availability of trained providers on NR and resuscitation equipment in private health facilities in Kano metropolis.
| Materials and Methods|| |
A semi-structured self-administered questionnaire was used to collect information from the participating health facilities. A convenient sampling method was adopted where 85 private health institutions that provide obstetric care as part of their services and located within the metropolis were selected from a database of the Kano state branch of Nigerian Medical Association. In each facility, the matron or medical officer in charge of the facility provided the responses in the questionnaire. Each facility was categorized as specialist clinic if there is trained specialist cover (obstetrician and/or pediatrician); general practice clinic if the facility is run by a general medical practitioner with no specialist training; and a maternity home/PHC if the facility is run by trained nurse/midwife with or without occasional doctor's cover. Facilities were identified by codes and the names of the participating institutions were not indicated on the questionnaires. Filled questionnaires were retrieved by a research assistant 1 month after issuance.
The survey data were analyzed with SPSS version 21.0 software. Quantitative variables were summarized as mean ± standard deviation or median, while qualitative variables were presented as frequencies and percentages.
| Results|| |
A total of 78 properly filled questionnaires were retrieved translating to a 91.8% response rate. There were a total of 25 (32.1%) specialist clinics, 44 (56.4%) general practice clinics, and 9 (11.5%) primary health care/maternity homes in the survey. The mean bed capacity of the facilities surveyed was 14.5 (SD = 7.95); the mean vaginal delivery rate per week was 4.2 while the cesarean delivery rate per month was 2.4 [Table 1].
The level of healthcare personnel usually in attendance during normal vaginal deliveries at the various health facilities is depicted in [Figure 1]. Of the 25 specialist clinics, 22 (88%) reported physician's presence among other lower cadre staff during vaginal deliveries. The corresponding figures for general practice clinics and primary healthcare/maternity centers were 37 (84.1%) and 1 (11.1%) respectively.
|Figure 1: Health personnel in attendance during normal deliveries. CHEW: Community health extension worker, PHC: Primary health care|
Click here to view
Only 34 (43.5%) of the facilities surveyed reported having a written protocol on NR. Thirteen (52%) of the specialist clinics had written protocol on NR while only 18 (41%) and 3 (33.3%) reported having same among the general practice clinics and maternity/PHC respectively.
Only one (1.3%) maternity home/PHC reported having a caregiver trained on NR routinely in attendance during normal deliveries. The corresponding figures for general practice and specialist clinics were 17 (38.6%) and 11 (44%) respectively [Figure 2].
|Figure 2: Availability of personnel trained on neonatal resuscitation. PHC: Primary health care|
Click here to view
In 38.5% of the facilities surveyed, nurses and midwives were the primary care personnel responsible for NR during operative deliveries [Figure 3]. This is followed by anesthetists (20.5%) and pediatrician (16.7%).
[Figure 4] depicts the availability of some basic NR equipment in the various facilities surveyed. There is universal availability of mucus extractor in all the maternity homes, but only two (22.2%) have functional ambu bags in their delivery rooms.
| Discussion|| |
Although the need for resuscitation of the newborn may be predictable, such circumstance may arise suddenly without warning. It is thus essential that a healthcare provider with the appropriate knowledge and skills required for NR be always present at every delivery.
This study revealed that only 37.2% (29) of the facilities surveyed reported presence of a provider trained in NR during deliveries. This figure is higher than what Ogunlesi and colleagues reported, where only 14% of the healthcare professionals have training on NR. This may have resulted from the fact that facilities were surveyed in our study, while Ogunlesi et al. studied individual nurses. Moreover, the presence of trained personnel in our study refers to all healthcare providers, irrespective of cadre (doctors inclusive) while Ogunlesi et al. studied only nurses/midwives working in the delivery room. Furthermore, the finding in our study may probably be an overestimation, as self-administered questionnaire may introduce bias of under reporting facility inadequacy or incompetence. Although more than 90% of babies may not require intervention to initiate spontaneous breath at birth, the simplicity of the skills required for basic resuscitation of newborn at birth (even in low resource settings), makes a compelling case for all providers to be trained on resuscitation of the newborns.
Less than half (43.5%) of all facilities surveyed reported having a written NR protocol in their centers. Expectedly, the proportion of facilities with NR protocol is higher among those facilities categorized as specialist clinics where services of specialist are available, followed closely by the general practice clinics.
An interesting finding in this study is the role played by anesthetists in resuscitation of the newborn during operative deliveries. In 20.5% of the facilities surveyed, the anesthetist was the primary resuscitator, surpassed only by the midwives (38%). This may be a reflection of the rising trend in the use of regional anesthesia for cesarean deliveries. Regional anesthesia, apart from being safer for both the mother and fetus, allows the attending anesthetist greater latitude to engage in secondary responsibilities like the resuscitation of the newborn.
Only two (22.2%) of the primary healthcare facilities in this survey had functional ambu bags in the delivery units. A relatively larger proportion of the general practice and specialist clinics reported having same in their delivery units [24 (54.5%) and 16 (64%) respectively]. These figures; however, remained inadequate considering the significance of ventilation in averting the negative sequelae of birth asphyxia. Though this study did not assess the skills of care providers, it is obvious that even where the knowledge and necessary skills for initiating positive pressure ventilation is available, lack of appropriate equipment may hinder progress and successful outcome during resuscitation.
The self-administered questionnaire tool used in this survey has obviously limited the validity of information volunteered by the respondents. There is tendency for respondents to understate deficiencies for fear of regulatory agencies. Furthermore, facilities rather than individual caregivers were the subject of assessment in this study. Thus, a facility with only one trained personnel NR (who can obviously not be around in all deliveries) may be classified under facilities with trained personnel.
| Conclusions and Recommendations|| |
We conclude from this survey that there is insufficient number of trained personnel on newborn resuscitation, and low availability of newborn resuscitation equipment in private health institutions in Kano metropolis.
Considering the role played by private health institutions in the delivery of healthcare, we recommend that organizers of trainings on the care of the newborn and resuscitation should encourage adequate representation of primary care providers from private healthcare facilities. Furthermore, regulatory bodies responsible for monitoring these facilities should ensure the availability of basic newborn resuscitation equipment in all facilities that render obstetric care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wall SN, Lee AC, Niermeyer S, English M, Keenan WJ, Carlo W, et al
. Neonatal resuscitation in low resource settings: What, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet 2009;107:S47-64.
Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room. Associated clinical events. Arch Pediatr Adolesc Med 1995;149:20-5.
Nwosu J, Odubanjo MO, Osinusi BO. Reducing maternal and infant mortality in Nigeria: Forum on evidence-based health policy making. Nigerian Academy of Science. Lagos, Nigeria: West African Book Publishers; 2009.
Edokwe ES. Neonatal Survival in Nigeria. Afrimedic J 2011;2:32-3.
Textbook of Neonatal Resuscitation. American Academy of Pediatrics, 5;2006.
Lee AC, Wall S, Cousens S, Carlo W, Niermeyer S, Keenan W, et al
. Neonatal resuscitation and simple immediate newborn care for the prevention of neonatal deaths.BMC Public Health 2011;11:S12.
Disu EA, Ferguson IC, Njokanma OF, Anga LA, Solarin AU, Olutekunbi AO, et al
. National neonatal resuscitation training program in Nigeria (2008-2012): A preliminary report. Niger J Clin Pract 2015;18:102-9.
] [Full text]
Lamina MA, Sule-Odu AO, Jagun EO. Factors militating against delivery among patients booked in Olabisi Onabanjo University Teaching Hospital, Sagamu. Niger J Med 2004;13:52-5.
Nwosu BO, Ugboaja JO, Obi-Nwosu AL, Igwegbe AO. Attitude of women towards private and public hospitals for obstetric care in South-East Nigeria: Implications for maternal mortality reduction. Orient Journal of Medicine 2012;24:1-6.
Ogunlesi AT, Dedeke IO, Adekanmbi AF, Fetuga MB, Okeniyi JA. Neonatal resuscitation: Knowledge and practice of nurses in western Nigeria. S Afr J Child Health 2008;2:23-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]