ArticlePloS one2020
Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 56 citations in OpenAlex.
- Teamwork and implementation of innovations in healthcare and human service settings: a systematic review.Implementation science : IS · 2024Pooled 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
- Article
- Comparison of methods of Weaning from Nasal Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial.Pakistan journal of medical sciences · 2026Article
- Newborn technology use in low-resource settings: the role of health professionals' communication in implementation.Health policy and planning · 2025Article
- Communication among health professionals using newborn technology for care: an exploratory scoping review.BMJ open quality · 2025Article
- Ending preventable maternal deaths in Malawi: the stakeholders consensus approach to identify maternal health needs priorities.BMC health services research · 2025Article
- Contextual factors influencing bubble continuous positive airway pressure implementation for paediatric respiratory distress in low-income and middle-income countries: a realist review.The Lancet. Global health · 2025Review
- Article
- Feasibility and integration of a novel bubble CPAP system into a public referral PICU in Mysuru, India.Frontiers in pediatrics · 2025Article
- Outcome of Nasal continuous positive airway pressure in neonates: A cross-sectional study.Pakistan journal of medical sciences · 2024Article
- Barriers and enablers of quality high-acuity neonatal care in sub-Saharan Africa: protocol for a synthesis of qualitative evidence.BMJ open · 2024Article
- Factors Influencing the Implementation of Infant Warming Devices Among Healthcare Workers in Malawian Hospitals.Global pediatric health · 2024Article
- Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi.PLoS medicine · 2024Article
- The Journey Toward Establishing Inpatient Care for Small and Sick Newborns in Ethiopia, India, Malawi, and Rwanda.Global health, science and practice · 2023Article
- Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi.BMJ open · 2023Article
- Impact of an Online Program of Bubble Continuous Positive Airway Pressure Education in a Resource-Constrained Setting.ATS scholar · 2023Article
- Feasibility and usability of a very low-cost bubble continuous positive airway pressure device including oxygen blenders in a Ugandan level two newborn unit.PLOS global public health · 2023Article
- Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals.BMC pediatrics · 2022Article
- Article
Corrections and comments
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Authors and funding
18 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundPreterm birth complications are the leading cause of neonatal deaths. Malawi has high rates of preterm birth, with 18.1 preterm births per 100 live births. More than 50% of preterm neonates develop respiratory distress which if left untreated, can lead to respiratory failure and death. Term and preterm neonates with respiratory distress can often be effectively managed with Continuous Positive Airway Pressure (CPAP) and this is considered an essential intervention for the management of preterm neonates by the World Health Organization. Bubble CPAP may represent a safe and cost-effective method for delivering CPAP in low-income settings.
objectiveThe study explored the factors that influence the implementation of bubble CPAP among health care professionals in secondary and tertiary hospitals in Malawi.
methodsThis was a qualitative study conducted in three district hospitals and a tertiary hospital in southern Malawi. We conducted 46 in-depth interviews with nurses, clinicians and clinical supervisors, from June to August 2018. All data were digitally recorded, transcribed verbatim and thematically analyzed.
resultsFactors that influenced implementation of bubble CPAP occurred in an interconnected manner and included: inadequate healthcare provider training in preparation for use, rigid division of roles and responsibilities among providers, lack of effective communication among providers and between providers and newborn's caregivers, human resource constraints, and inadequate equipment and infrastructure.
conclusionThere are provider, caregiver and health system level factors that influence the implementation of bubble CPAP among neonates in Malawian health facilities. Ensuring adequate staffing in the nurseries, combined with ongoing training for providers, team cohesion, improved communication with caregivers, and improved hospital infrastructure would ensure optimal utilization of bubble CPAP and avoid inadvertent harm from inappropriate use.
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