Researchers from the Centre for Maternal and Newborn Health (CMNH) have conducted a study on the use of Continuous Positive Airway Pressure (CPAP) in India. The qualitative study, which explored the views of 18 doctors and 51 nurses from 15 neonatal units in government hospitals across Andhra Pradesh (a state in south-east India), has been published in BMC Pediatrics: Healthcare workers’ views on the use of continuous positive airway pressure (CPAP) in neonates: a qualitative study in Andhra Pradesh, India.
CPAP is a form of breathing support commonly used to manage severe breathing difficulties in newborn babies. Every year, an estimated 2.9 million newborn babies die, most of which following complications caused by prematurity, difficult births and/or infections. Difficulty in breathing is a common problem associated with these conditions, and could lead to death in up to 1 in 5 babies in low- and middle-income countries (LMICs). CPAP is therefore a vital tool for healthcare providers in these settings.
Unlike mechanical ventilation (an alternative form of breathing support), CPAP does not require complex technical expertise and CPAP devices are simpler and easier to maintain and repair. Therefore, there is growing interest in expanding the use of CPAP in LMICs. However, when used without well-functioning equipment and close monitoring, CPAP may lead to rare but potentially serious complications for the newborn, such as leakage of air from the lungs, blindness and infections. It is therefore vital that the correct mechanisms are in place to ensure safe delivery of CPAP while introducing or expanding its use in LMICs.
In India, 779,000 newborn babies die each year. CPAP is used in 68% of government medical colleges and 36% of government district hospitals. However, not all of the mechanisms to ensure safe use of CPAP are available in some of these hospitals. This could potentially discourage healthcare workers from using CPAP. Little is known about the views of doctors and nurses about using CPAP for newborn babies in hospitals with limited resources, yet these views are essential to inform future scaling-up of this intervention in India and other LMIC settings. Our research sought to explore the experiences and views of healthcare providers on the enablers and barriers to implementing CPAP in neonatal units in India.
Professor Matthews Mathai, Chair in Maternal and Newborn Health at CMNH, corresponding author of this study:
“Our research found that the common challenges limiting the use of CPAP were shortages of staff, consumables and equipment, and problems about the organisation of neonatal units in both district hospitals and medical colleges. This meant that CPAP was often not available for babies that needed it or that the best quality of care could not be provided. Providing care under constrained circumstances left staff feeling powerless to provide good quality care for neonates with severe breathing difficulties. Despite the challenges, these staff were enthusiastic about the use of CPAP and its potential to save lives. CPAP use was mostly perceived as technically easier to provide than mechanical ventilation and that it allowed nurses to provide advanced neonatal care, independently of doctors. Overall, while doctors and nurses embraced CPAP use, the identified challenges to provision of quality care should be addressed first before expanding the use of CPAP across more hospitals.
These results only relate to CPAP use in one state in India. CMNH has also conducted a study to explore CPAP use across the whole country via a nationwide survey (awaiting publication). We have also completed a national survey on CPAP in Kenya. We look forward to sharing results from these further studies, which will help governments in LMICs to prioritise investments that will improve facility-based newborn care.”