Observational studyBMC pediatrics2019
Reducing preterm mortality in eastern Uganda: the impact of introducing low-cost bubble CPAP on neonates <1500 g.
Observational study in BMC pediatrics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Continuous Positive Airway Pressure (CPAP) for severe pneumonia in low- and middle-income countries: A systematic review of contextual factors.Journal of global health · 2022Pooled it
- Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis.BMJ global health · 2021Pooled it
- Acceptability of immediate CPAP for preterm infants in the delivery room to mothers, caregivers and healthcare workers in a low-resource setting: a qualitative study.BMC pediatrics · 2025Trial
- Health interventions and stakeholder roles in neonatal mortality reduction within low-income countries: A scoping review.Public health in practice (Oxford, England) · 2026Review
- Article
- Oxygen blenders for prevention of retinopathy of prematurity are highly cost-effective in Uganda.Frontiers in medicine · 2026Article
- Comparison of Ventilator-Derived and Modified Bubble Continuous Positive Airway Pressure for Early Stabilization of Transient Tachypnea of the Newborn: A Retrospective Cohort Study in a Transitional Care Unit.Turkish archives of pediatrics · 2025Article
- Article
- Implementation of a novel bubble continuous positive airway pressure system with a blender in preterm infants in a low resource setting.Journal of perinatology : official journal of the California Perinatal Association · 2025Article
- A survey on the use of continuous positive airway pressure in newborn care in Kenya in 2017-2018.PloS one · 2025Article
- Evaluating the Feasibility of a Nonelectric Bubble CPAP System in the NICU of a Philippine Regional Referral Hospital: A Qualitative Study.International journal of pediatrics · 2025Article
- Impact of early continuous positive airway pressure in the delivery room (DR-CPAP) on neonates < 1500 g in a low-resource setting: a protocol for a pilot feasibility and acceptability randomized controlled trial.Pilot and feasibility studies · 2024Article
- Perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda: a qualitative study.BMC pediatrics · 2023Article
- Prevalence and Missed Cases of Respiratory Distress Syndrome Disease Amongst Neonatal Deaths Enrolled in the Kenya Child Health and Mortality Prevention Surveillance Network (CHAMPS) Program Between 2017 and 2021.Global pediatric health · 2023Article
- 'They said, let's teach you how you are going to care for the child at home…': caregivers' and healthcare worker's perceptions and experiences of post-discharge preterm care in eastern Uganda.BMC health services research · 2022Article
- 2.5 Million Annual Deaths-Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality.Tropical medicine and infectious disease · 2022Review
- Article
- Growth of a cohort of very low birth weight and preterm infants born at a single tertiary health care center in South Africa.Frontiers in pediatrics · 2022Article
- Innovations and adaptations in neonatal and pediatric respiratory care for resource constrained settings.Frontiers in pediatrics · 2022Review
- Respiratory Interventions for Preterm Infants in LMICs: A Prospective Study From Cape Town, South Africa.Frontiers in global women's health · 2022Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundComplications of prematurity are the leading cause of deaths in children under the age of five. The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods.
methodsThis was a retrospective study of VLBW neonates (weight < 1500 g) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates < 1500 g were compared before and after the introduction of bCPAP.
resultsThe admission records of 377 VLBW neonates < 1500 g were obtained. One hundred fifty-eight were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P = 0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36-0.86, P = 0.01). There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups.
conclusionSpecialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths. The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.
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