Assessing the capacity for newborn resuscitation and factors associated with providers’ knowledge and skills: a cross-sectional study in Afghanistan

BMC Pediatrics

Jelle Stekelenburg¹  Jos van Roosmalen⁷  Kai Sun²  Richard Semba²  Patricia Bailey³  Partamin Zainullah⁶  Sheena Currie⁵  Hannah Tappis⁴  Adrienne Kols⁵  Nasratullah Ansari⁶  Young Mi Kim⁵ 

[1]Department of Obstetrics & Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands

[2]Johns Hopkins Medical Institute (JHMI), Baltimore, MD, USA

[3]FHI 360 and Averting Maternal Death & Disability, Durham, NC, USA

[4]Johns Hopkins School of Public Health (JHSPH), Baltimore, MD, USA

[5]Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA

[6]Jhpiego/Afghanistan, an affiliate of Johns Hopkins University, Kabul, Afghanistan

[7]Free University, Amsterdam, The Netherlands

关键词: Lower income countries;    Afghanistan;    Newborn resuscitation;    Neonatal mortality;    Emergency obstetric care;    Birth asphyxia;    Intrapartum hypoxia;   

Others  :  1144529
DOI  :  10.1186/1471-2431-13-140

 received in 2013-05-10, accepted in 2013-09-05,  发布年份 2013

【 摘 要 】

Background

Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in resource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering comprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility characteristics associated with providers’ knowledge and clinical skills.

Methods

Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn resuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and infrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses were performed using STATA 11.2 and SAS 9.1.3.

Results

Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag, and mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely than doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No significant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in performing newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge questions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in their ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and clinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience offering EmONC services.

Conclusions

Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan, but providers’ knowledge and skills need strengthening in some areas. Midwives proved to be as capable as doctors of performing newborn resuscitation, which validates the major investment made in midwifery education. Competency-based pre-service and in-service training, complemented by supportive supervision, is an effective way to build providers’ capacity to perform newborn resuscitation. This kind of training could also help skilled birth attendants based in the community, at private clinics, or at primary care facilities save the lives of newborns.

【 授权许可】

   
2013 Kim et al.; licensee BioMed Central Ltd.

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