Silent voices of the midwives: factors that influence midwives’ achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry

Abstract Background In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery). Methods This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes. Results Thematic analysis of the midwives’ responses revealed three factors that influence successful resuscitation: 1. Hands-on training (“HOT”) with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother’s bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research. Conclusions Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of “HOT” real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife’s beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.

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PERCEPTIONS OF TRAINEES ABOUT USE OF SIMULATION IN GYNAECOLOGY AND OBSTETRICS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v6i6.4277 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2001-06

Author(s):

Maimoona Hafeez ◽

Nudrat Sohail ◽

S H Waqar

Keyword(s):

Clinical Experience ◽

Thematic Analysis ◽

Simulation Training ◽

Clinical Performance ◽

Clinical Skills ◽

Qualitative Interviews ◽

Real Life ◽

Sampling Technique ◽

Second Phase ◽

Obstetrics And Gynaecology

Objective: To explore the perception of Obstetrics and Gynaecology (OB/GYN) postgraduates about the use of simulation in improving their clinical skills. Study Design: Explanatory sequential mixed method design. Place and Duration of Study: Obstetrics and Gynaecology department of Sharif Medical and Dental City (SMDC) Lahore Pakistan, from Jun to Oct 2019. Methodology: By using a homogenous purposive sampling technique eight postgraduate residents from Obstetrics and Gynaecology department were recruited. The study had two phases: In the first phase, quantitative data was collected and analyzed while in the second phase qualitative data were collected by following the quantitative phase and then analyzed. This framework was tracked through the procedure of instrumental delivery with vacuum application in a real-life situation. A survey was conducted before and after the simulation training by using a researcher-developed Likert scale questionnaire. After that in-depth qualitative interviews were conducted. The improvement in clinical performance was evaluated by pairedsample t-test and thematic analysis. Results: Significant performance improvement (p<0.001) after simulation training was reported. The thematic analysis revealed a lack of proficiency in clinical experience before simulation at behavioural and technical levels while enhancement in clinical experience after simulation at both levels. The perceived benefits of simulation with the major trends of simulation as time-friendly, as a source of deliberate practice, and as safe practice in the unthreatened environment were explored. The theme of suggestions was also explored. Conclusion: The participants showed improvement in their clinical skills by describing the optimized benefits of simulation. Few of them are.......

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Timing and causes of neonatal mortality in Tamale Teaching Hospital, Ghana: A retrospective study

PLoS ONE ◽

10.1371/journal.pone.0245065 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245065

Author(s):

Alhassan Abdul-Mumin ◽

Cesia Cotache-Condor ◽

Sheila Agyeiwaa Owusu ◽

Haruna Mahama ◽

Emily R. Smith

Keyword(s):

Retrospective Study ◽

Preterm Birth ◽

Neonatal Mortality ◽

Teaching Hospital ◽

Neonatal Death ◽

Birth Asphyxia ◽

Sub Saharan Africa ◽

Neonatal Deaths ◽

Birth Complications ◽

Tamale Teaching Hospital

Neonatal deaths now account for more than two-thirds of all deaths in the first year of life and for about half of all deaths in children under-five years. Sub-Saharan Africa accounts up to 41% of the total burden of neonatal deaths worldwide. Our study aims to describe causes of neonatal mortality and to evaluate predictors of timing of neonatal death at Tamale Teaching Hospital (TTH), Ghana. This retrospective study was conducted at TTH located in Northern Ghana. All neonates who died in the Neonatal Intensive Care Unit (NICU) from 2013 to 2017 were included and data was obtained from admission and discharge books and mortality records. Bivariate and multivariate logistic regression were used to assess predictors of timing of neonatal death. Out of the 8,377 neonates that were admitted at the NICU during the 5-year study period, 1,126 died, representing a mortality rate of 13.4%. Of those that died, 74.3% died within 6 days. There was an overall downward trend in neonatal mortality over the course of the 5-year study period (18.2% in 2013; 14.3% in 2017). Preterm birth complications (49.6%) and birth asphyxia (21.7%) were the top causes of mortality. Predictors of early death included being born within TTH, birth weight, and having a diagnosis of preterm birth complication or birth asphyxia. Our retrospective study found that almost 3/4 of neonatal deaths were within the first week and these deaths were more likely to be associated with preterm birth complications or birth asphyxia. Most of the deaths occurred in babies born within health facilities, presenting an opportunity to reduce our mortality by improving on quality of care provided during the perinatal period.

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Neonatal resuscitation practices in Uganda: a video observational study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001092 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001092

Author(s):

Daniel Helldén ◽

Susanna Myrnerts Höök ◽

Nicolas J Pejovic ◽

Dan Mclellan ◽

Clare Lubulwa ◽

...

Keyword(s):

Observational Study ◽

Neonatal Resuscitation ◽

Birth Asphyxia ◽

Sub Saharan Africa ◽

Positive Pressure ◽

Clinical Practices ◽

Exact Test ◽

Low Resource Settings ◽

Low Resource ◽

Sub Saharan

BackgroundNeonatal mortality, often due to birth asphyxia, remains stubbornly high in sub-Saharan Africa. Guidelines for neonatal resuscitation, where achieving adequate positive pressure ventilation (PPV) is key, have been implemented in low-resource settings. However, the actual clinical practices of neonatal resuscitation have rarely been examined in these settings. The primary aim of this prospective observational study was to detail the cumulative proportion of time with ventilation during the first minute on the resuscitation table of neonates needing PPV at the Mulago National Referral Hospital in Kampala, Uganda.MethodsFrom November 2015 to January 2016, resuscitations of non-breathing neonates by birth attendants were video-recorded using motion sensor cameras. The resuscitation practices were analysed using the application NeoTapAS and compared between those taking place in the labour ward and those in theatre through Fisher’s exact test and Wilcoxon rank-sum test.ResultsFrom 141 recorded resuscitations, 99 were included for analysis. The time to initiation of PPV was 66 (42–102) s overall, and there was minimal PPV during the first minute in both groups with 0 (0–10) s and 0 (0–12) s of PPV, respectively. After initiating PPV the overall duration of interruptions during the first minute was 28 (18–37) s. Majority of interruptions were caused by stimulation (28%), unknown reasons (25%) and suction (22%).ConclusionsOur findings show a low adherence to standard resuscitation practices in 2015–2016. This emphasises the need for continuous educational efforts and investments in staff and adequate resources to increase the quality of clinical neonatal resuscitation practices in low-resource settings.

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Evaluation of concomitant corticosteroid and vedolizumab use in patients with inflammatory bowel disease (IBD) in real-life clinical practice

10.26226/morressier.59a6b34cd462b80290b5596b ◽

2017 ◽

Author(s):

Taina Sipponen

Keyword(s):

Inflammatory Bowel Disease ◽

Clinical Practice ◽

Bowel Disease ◽

Real Life ◽

Inflammatory Bowel

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How many CCS- and ACS-patients might reach the newly recommended LDL-C-target <55mg/dl in clinical practice if guidelines were applied – an estimate from the DYSIS II study population

European Heart Journal ◽

10.1093/ehjci/ehaa946.1445 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A.K Gitt ◽

M Horack ◽

D Lautsch ◽

R Zahn ◽

J Ferrieres

Keyword(s):

Clinical Practice ◽

Real Life ◽

Statin Treatment ◽

Lipid Lowering ◽

High Risk Population ◽

High Dose ◽

Funding Source ◽

Pcsk9 Inhibitors ◽

Target Values ◽

Coronary Syndromes

Abstract Background The 2019 ESC guidelines for the management of dyslipidemia even further lowered the LDL-C-target values for the very high-risk population from <70mg/dl to <55mg/dl. Population based studies already had shown that the previous target was difficult to reach. It is yet unclear how many patients in clinical practice might be treated to the new target. Methods The Dyslipidemia International Study (DYSIS II) prospectively collected data of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS) (all on statins) in 18 countries in Europe, the Middle East, South- and East Asia to document patient characteristics, medication and a current lipid profile from 2012 to 2014 under real life conditions in physicians' offices and hospitals. We took these real-life lipid profiles and data on the kind/dose of used statins to estimate how treatment escalation such as changing statin treatment to a high dose (atorvastatin ≥40mg / rosuvastatin≥20mg), adding ezetimibe and adding a PCSK9-inhibitor might help to bring LDL-C-levels to the recommended <55mg/dl target. Results A total of 7,865 patients were enrolled into DYSIS II, 6,794 had CCS and 1,071 ACS. Under the documented statin treatment in DYSIS only 12.7% of patients reached an LDL-C <55mg/dl. Putting all patients on high dose statins in combination with ezetimibe, 64.1% would reach the target. If PCSK9-inhibitors would be used in the remaining patients not at goal a total of 94.0% would match the goal. Conclusion Our analysis indicates that in real life practice the use available lipid-lowering medications would substantially increase the percentage of CCS- and ACS-patients reaching the newly recommended 2019 ESC guideline LDL-C-target of <55 mg/dl from less than 20% to more than 90% of the population. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD

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CP-078 Optimisation of biological therapy in established rheumatoid arthritis patients in real life clinical practice

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2016-000875.78 ◽

2016 ◽

Vol 23 (Suppl 1) ◽

pp. A34.2-A34

Author(s):

M Cárdenas ◽

P Font ◽

S De la Fuente ◽

MC Castro-Villegas ◽

M Romero-Gómez ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Biological Therapy ◽

Real Life ◽

Established Rheumatoid Arthritis

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The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

Children ◽

10.3390/children8060526 ◽

2021 ◽

Vol 8 (6) ◽

pp. 526

Author(s):

James Ditai ◽

Aisling Barry ◽

Kathy Burgoine ◽

Anthony K. Mbonye ◽

Julius N. Wandabwa ◽

...

Keyword(s):

Low Cost ◽

Neonatal Resuscitation ◽

Sub Saharan Africa ◽

Skilled Birth Attendants ◽

New Device ◽

Birth Attendants ◽

Premature Babies ◽

Sub Saharan ◽

The Uk ◽

The University

The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK.

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