Neonatal Resuscitation Practices and Associated Factors Among Nurses in Tanzanian Delivery Suites: A Cross-Sectional Study

TL;DR

This study examines how well nurses in Tanzania perform neonatal resuscitation and finds that training and experience are key to improving outcomes.

Contribution

The study identifies working experience as an independent predictor of neonatal resuscitation practice among nurses in Tanzania.

Findings

Only 52% of neonatal resuscitation cases met standard guidelines.

Working experience of 3 to 5 years was an independent predictor of better resuscitation practice.

Formal and in-house training were associated with improved resuscitation practices.

Abstract

Neonatal deaths contribute significantly to under-five mortality, with most deaths seen in sub-Saharan Africa (SSA). Birth asphyxia is the leading cause of these deaths, but it is preventable with effective resuscitation. In SSA, including Tanzania, inadequate neonatal resuscitation practice by health care providers has been identified as a significant contributor to neonatal mortality.

The study aimed to assess the current practice of neonatal resuscitation and the associated factors among nurses located in the delivery suites.

A hospital-based cross-sectional study was done at Muhimbili National Hospital. It involved the direct observation of 138 cases of neonatal resuscitation(NR) by 49 nurses. Proportions were used to assess practice. The chi-square and Fisher's Exact Tests were used to determine associations between provider characteristics and practice. Logistic regression models were used to identify independent predictors of practice.

Overall, 52% of neonatal resuscitation cases met standard guidelines. Adequate drying was performed in 82.6% of cases, but inappropriate stimulation occurred in 16.7%, and wet towels were discarded in only 38.4%. Initial assessment was correct in 49.6%, and airway opening in 73.3%. A good mask seal was achieved in 93%, yet the first rescue breath was correctly given in 32.1% and the second course in 27.2%. One newborn required chest compressions, but they were incorrectly done. Documentation post-resuscitation was done in only 2.9% of cases. Formal training (cOR 0.181; 95% CI, 0.038 to 0.871; P=.033), in-house training (P=.049), work experience (cOR 0.368; 95% CI, 0.161 to 0.839; P=.017), and knowledge of neonatal resuscitation (cOR 0.392; 95% CI, 0.197 to 0.781; P=.008 were associated with neonatal resuscitation practice. Working experience of 3 to 5 years (AOR .352; 95% CI, 0.148 to 0.836; P=.018) was found to be an independent predictor of practice.

Neonatal resuscitation is still a challenge among providers working in delivery suites. Working experience is an independent predictor of practice, but other factors, such as knowledge level, training, and ongoing in-house training, are equally important. Regular training, integration of neonatal resuscitation into continuous professional development, and embedding resuscitation performance in quality improvement frameworks are recommended.

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