Evidence map›Paper›PMID 33292844›Full record

ArticleImplementation science communications2020

Scaling up newborn care technologies from tertiary- to secondary-level hospitals in Malawi: an implementation case study of health professional perspectives on bubble CPAP.

Mai-Lei Woo Kinshella, Sangwani Salimu, Tamanda Hiwa, Mwai Banda, Marianne Vidler, Laura Newberry, Queen Dube, Elizabeth M Molyneux, David M Goldfarb, Kondwani Kawaza and 1 more

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Article in Implementation science communications, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Mai-Lei Woo KinshellaDepartment of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.
Sangwani SalimuDepartment of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Tamanda HiwaDepartment of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Mwai BandaDepartment of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Marianne VidlerDepartment of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.
Laura NewberryDepartment of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Queen DubeQueen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi.
Elizabeth M MolyneuxDepartment of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
David M GoldfarbDepartment of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.
Kondwani KawazaDepartment of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Alinane Linda Nyondo-MipandoSchool of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi. lmipando@medcol.mw.ORCID http://orcid.org/0000-0002-3572-3810

Funding

International Development Research Centre 108030
6 · The paper itself

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.

Indexed as

Bubble continuous positive airway pressure (CPAP)Health worker perspectivesImplementationMalawiNewborn careTertiary- and secondary-level care differences

Identifiers

PMID33292844
PMCPMC7640662

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.