Adherence to newborn resuscitation guidelines in Garissa Provincial General Hospital

Abstract

Background: Appropriate resuscitation techniques are crucial to the survival of the newborn. It is estimated that approximately 10% of newborns require assistance with breathing at birth. The W.H.O guidelines for neonatal resuscitation have been adopted by the Ministry of Health and it is recommended that all delivery room personnel complete the Newborn Resuscitation Program (NRP) training in order to improve the outcome of the resuscitation. Justification: Newborn resuscitation skills are mandatory to the all health workers who attend to mothers in labour. These skills are acquired through training and frequent practicing. No study has been conducted to assess the utilization of newborn resuscitation guidelines in Garissa P.G.H. Objective: The aim of the study was to establish the level of adherence to the Newborn Resuscitation guidelines by health workers in Garissa P.G.H. Methods: It was a descriptive hospital based cross- sectional study conducted in the labour ward and the theatre departments of Garissa PGH. Thirty nine (39) health workers were observed during resuscitation for a period of two months. Eleven resuscitation steps were observed. To measure the level of adherence to the guidelines, four initial basic steps were used to judge appropriate practice. The health worker had to fully achieve them as follows; receive the baby in warm towels, used a warm resuscitaire, positioned the baby in a neutral position and assessed breathing in the newborn. A questionnaire was also administered to establish barriers to effective resuscitation. Simple frequency tables were generated for analysis of appropriate resuscitation practice and compared with the health worker demographics. Multivariate logistic regression was used to determine independent correlates of appropriate resuscitation practice. Results: From the 136 resuscitations observed, 26.5% (n=36) were performed appropriately. The doctors were found to performed resuscitation more appropriately than the nurses (OR 6.45, p=<0.001). The most commonly missed steps were provision of warmth by use of warm towels (39%) and failure to assess the newborn’s adequacy of breathing (39%).Of the 30 health workers who responded to the questionnaire, 15 (50%) cited that lack of equipment needed for resuscitation was the main barrier to effective newborn resuscitation. Twelve workers (40%), reported lack of training in newborn resuscitation as the main barrier. Conclusion: The basic newborn resuscitation practice according to the guidelines was poorly adhered to at 26.5% of the cases observed. Recommendations: It is a possibility that emphasis on newborn resuscitation training and refreshers courses for the health workers may be addressed to increase the adherence level to the guidelines.