Barriers to optimal use of continuous positive airway pressure machines in preterm babies with respiratory distress syndrome at a Tertiary Referral Hospital in Addis Ababa, Ethiopia

Abstract

Background: Neonatal mortality is a significant contributor to under-five mortality in low-income countries like Ethiopia, carrying neonatal mortality of 30 per 1000 live births. Preterm newborns with respiratory distress can be effectively managed with a Continuous Positive Airway pressure machine. It is recommended as an essential lifesaving intervention by the World Health Organization. The study aimed to assess barriers to the optimal use of continuous positive airway pressure machines in preterm babies by Pediatrics residents at a tertiary referral hospital.

Methods: A hospital-based cross-sectional study was carried out among pediatric residents at Tikur Anbessa Specialized Hospital from September to October 2021. The data were collected through a self-administered structured questionnaire and analyzed using SPSS version 25. A P-value <0.05 was considered statistically significant.

Results: One hundred twelve pediatrics residents were included; 41(36.6%) were females and 89 (79.5 %) were aged between 25-30 years and 106 (94.6%) had NICU experience of less than one year. Forty-one (36.6%) had a moderate level of practicing continuous positive airway pressure safety checklists. There was a statistically significant difference in the practice of CPAP safety checklist usage with the year of residency (P= 0.001). A majority, 90 (80.4%), of `pediatrics residents used locally-made improvised water bottle systems as bubble continuous positive airway pressure machines. The perceived barriers to continuous positive airway pressure machine use included lack of commercial bubble machine, 77 (85.5%), unavailability of oxygen, and lack of appropriately sized nasal prongs.

Conclusion:  Lack of commercial continuous positive airway pressure machines and essential equipment were the reported barriers. Tackling the perceived barriers would contribute to the national effort to decrease neonatal mortality and achieve Sustained Development-3.