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Barriers to and Facilitators for Newborn Resuscitation in Malawi, Africa

Authors

  • Kent D.W. Bream MD,

    Corresponding author
      Kent D.W. Bream, MD, Department of Family Practice and Community Medicine, 2 Gates HUP-3400 Spruce Street, Philadelphia, PA 19104. E-mail: bream@mail.med.upenn.edu
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    • Kent D.W. Bream, MD, is an Instructor and Associate Director of Predoctoral Education in the Department of Family Practice and Community Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.

  • Susan Gennaro RN, DSN,

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    • Susan Gennaro, RN, DSN, FAAN, is a Professor in the University of Pennsylvania School of Nursing, Philadelphia, PA.

  • Ursula Kafulafula RN, MSN,

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    • Ursula Kafulafula, RN, MSN, is a lecturer at Kamuzu College of Nursing, Blantyre, Malawi.

  • Ellen Mbweza RN, MSN,

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    • Ellen Mbweza, RN, MSN, is a lecturer at Kamuzu College of Nursing, Blantyre, Malawi.

  • David Hehir MD

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    • David Hehir, MD, is a fellow at the Children's Hospital of Philadelphia, Philadelphia, PA.


Kent D.W. Bream, MD, Department of Family Practice and Community Medicine, 2 Gates HUP-3400 Spruce Street, Philadelphia, PA 19104. E-mail: bream@mail.med.upenn.edu

Abstract

Newborn resuscitation is a key component of efforts to reduce neonatal morbidity and mortality. This article reports the findings of focus groups conducted to explore the barriers and facilitators present for obstetric nurse providers in a central urban hospital in Malawi regarding the training and provision of neonatal resuscitation. All obstetric nurse providers in this setting participated in focus groups; these groups identified 4 themes: 1) confidence in their skills in assessing newborns and recognizing the need for resuscitation, 2) a lack of resources, 3) facilitators who would enable them to introduce resuscitation, and 4) solutions to the current problems. Resource shortages and barriers to providing care included availability of staff, equipment, and supplies; labor ward geography; ethical dilemmas; and the lack of standard protocols regarding newborn resuscitation. Facilitators were professional experience and the critical load of deliveries performed. Solutions to barriers included small resource additions as well as long-term policy changes. With standard policy and protocols, experienced, confident nurses could overcome the barriers to providing newborn resuscitation. This group identified ways to change systems to decrease infant mortality, thereby improving the health and quality of life of women receiving care in Malawi.

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