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Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource
Sara Dada1, Henry Ashworth1,2, Alina Sobitschka1,3
1Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America.
Insights
Implementing Continuous Positive Airway Pressure (CPAP) in low-resource settings requires user-friendly devices and robust training. Addressing barriers like unreliable electricity and supply chains is crucial for sustainable neonatal respiratory support.
Area of Science:
- Neonatal Medicine
- Public Health
- Medical Devices
Background:
- Continuous Positive Airway Pressure (CPAP) is a vital non-invasive respiratory support for neonates in high-resource areas.
- Its safety is established in low-resource settings, but implementation barriers and facilitators remain under-researched.
Purpose of the Study:
- To identify and describe barriers, facilitators, and priorities for implementing CPAP in low-resource settings for neonates and infants.
Main Methods:
- A systematic literature search was conducted across multiple databases (MEDLINE, Embase, etc.) from inception to March 2020.
- PRISMA-ScR guidelines were followed, including original research on CPAP implementation, perspectives, and economic analyses.
- Inductive content analysis was used to synthesize findings from 54 included studies.
Main Results:
- Six themes emerged: device attributes, patient, parent, and provider experiences, barriers, and facilitators.
- Common complication: nasal trauma. Key barriers: unreliable electricity, lack of bioengineering support.
- Facilitators: training, mentorship, provider empowerment. Device design, supply chain, and training models are critical.
Conclusions:
- Sustainable CPAP implementation necessitates user-friendly devices, accessible consumables, and comprehensive, user-driven training.
- Further research should focus on standardizing metrics, optimizing provider performance interventions, and long-term health system integration.
Background:
Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation.
Objective:
To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings.
Methods:
A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted.
Findings:
1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP.
Conclusion:
Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration.
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