Resuscitation 85 (2014) e31–e32
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor
Neonatal resuscitation skills amongst healthcare workers in Bo district, Sierra Leone夽 Sir, The neonatal mortality rate in Sierra Leone is amongst the highest in the world. Currently 1 in 20 newborns does not survive the neonatal period.1 Of these deaths, 35% occur within 24 h of delivery.1 A substantial portion of these newborns never leave the labour ward alive. There is good evidence that neonatal resuscitation can reduce the burden of early neonatal mortality in developing countries,2 where the implementation of newborn life support programmes may reduce term intrapartum-related deaths by up to 30%.3 This makes it potentially one of the most effective interventions available. In view of the high rates of neonatal death in Sierra Leone, this assessment aimed to evaluate the baseline retention of previous training in Bo district and the need for further staff training. Data were collected during routine visits to all 6 emergency obstetric and neonatal referral centres in Bo district, Sierra Leone, as part of a joint VSO/UNICEF/Ministry of Health and Sanitation programme of staff training. Assessment of healthcare workers was carried out by a physician with significant experience in neonatal care and training. The staff assessed included Midwives (n = 5), Nurses (n = 18), Community Health Officers (n = 4), Traditional Birth Attendants (n = 2), Maternal and Child Health Aides (n = 10) and Community Health Assistants (n = 3). Staff performance was categorised as: Excellent resuscitation: The candidate performed all of the critical steps involved in neonatal resuscitation, as laid out in a set of established guidelines (Helping Babies Breathe guidelines or UK Resuscitation Council Guidelines) Identified the need for and successfully commenced resuscitation: The candidate managed to identify the need for resuscitation and deliver at least one rescue breath via the bag mask device. Inadequate resuscitation: The candidate did not identify the need for resuscitation and/or did not give any inflation breaths or adequate ventilation breaths. Confidence intervals (CIs) were calculated for proportions (p) √ using p ± z (p(1 − p)/n), where z is the z-score at 1 − ˛/2, with ˛ = 0.05 for 95% CI.4
夽 A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.11.011. 0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.11.011
Table 1 Grades achieved by healthcare workers, presented as crude numbers and % of total with 95% CI. Grade Excellent resuscitation Identified the need for and commenced resuscitation Inadequate resuscitation
Number
% (95% CI)
0 6
0 14 (7–28)
36
86 (72–93)
As this was a quality assurance audit, formal ethics committee approval was not sought. Permission to publish the results was obtained from the Ministry of Health and Sanitation, Sierra Leone. Forty-two candidates were assessed (Table 1) with 86% graded as “inadequate”, and the remainder having “identified the need for and commenced resuscitation”. Nobody performed “excellent resuscitation”. However almost everybody dried the baby immediately after birth, with only 3 candidates missing this step. 81% were unable to identify the need for resuscitation and 97% were unable to perform effective ventilation breaths on a manikin (Baby Anne, Laerdal). Not all candidates attempted cardiac massage; this is likely to be due to its non-inclusion in some training courses. 86% attempted chest compressions, but none were able to perform them adequately. The results of this assessment show that the ability of healthcare staff in Bo district to perform neonatal resuscitation is potentially very limited. The data are particularly important because of the high national neonatal mortality rate and because they were obtained from assessments carried out in obstetric/neonatal referral centres. Conflict of interest None of the authors have any conflict of interest to state. References 1. Surviving the first day. State of the world’s mothers 2013. London: Save the Children; 2013. http://www.savethechildrenweb.org/SOWM-2013/ 2. Opiyo N, Were F, Govedi F, et al. Effect of newborn resuscitation training on health worker practices in Pumwani Hospital, Kenya. PLoS ONE 2008;3:e1599. 3. Lee A, Cousens S, Wall S, et al. Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health 2011;11:S12. 4. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 1998;17:857–72.
e32
Letter to the Editor / Resuscitation 85 (2014) e31–e32
Niall Conroy ∗ Chernor S. Jalloh Louise Mitchell Anita Solanki Ahmed Seedat Stephen B. Lambert Bo Government Hospital, Bo District, Sierra Leone
∗ Corresponding
author. Tel.: +232 77623859. E-mail address: [email protected] (N. Conroy) 6 November 2013 7 November 2013
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor
Neonatal resuscitation skills amongst healthcare workers in Bo district, Sierra Leone夽 Sir, The neonatal mortality rate in Sierra Leone is amongst the highest in the world. Currently 1 in 20 newborns does not survive the neonatal period.1 Of these deaths, 35% occur within 24 h of delivery.1 A substantial portion of these newborns never leave the labour ward alive. There is good evidence that neonatal resuscitation can reduce the burden of early neonatal mortality in developing countries,2 where the implementation of newborn life support programmes may reduce term intrapartum-related deaths by up to 30%.3 This makes it potentially one of the most effective interventions available. In view of the high rates of neonatal death in Sierra Leone, this assessment aimed to evaluate the baseline retention of previous training in Bo district and the need for further staff training. Data were collected during routine visits to all 6 emergency obstetric and neonatal referral centres in Bo district, Sierra Leone, as part of a joint VSO/UNICEF/Ministry of Health and Sanitation programme of staff training. Assessment of healthcare workers was carried out by a physician with significant experience in neonatal care and training. The staff assessed included Midwives (n = 5), Nurses (n = 18), Community Health Officers (n = 4), Traditional Birth Attendants (n = 2), Maternal and Child Health Aides (n = 10) and Community Health Assistants (n = 3). Staff performance was categorised as: Excellent resuscitation: The candidate performed all of the critical steps involved in neonatal resuscitation, as laid out in a set of established guidelines (Helping Babies Breathe guidelines or UK Resuscitation Council Guidelines) Identified the need for and successfully commenced resuscitation: The candidate managed to identify the need for resuscitation and deliver at least one rescue breath via the bag mask device. Inadequate resuscitation: The candidate did not identify the need for resuscitation and/or did not give any inflation breaths or adequate ventilation breaths. Confidence intervals (CIs) were calculated for proportions (p) √ using p ± z (p(1 − p)/n), where z is the z-score at 1 − ˛/2, with ˛ = 0.05 for 95% CI.4
夽 A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.11.011. 0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.11.011
Table 1 Grades achieved by healthcare workers, presented as crude numbers and % of total with 95% CI. Grade Excellent resuscitation Identified the need for and commenced resuscitation Inadequate resuscitation
Number
% (95% CI)
0 6
0 14 (7–28)
36
86 (72–93)
As this was a quality assurance audit, formal ethics committee approval was not sought. Permission to publish the results was obtained from the Ministry of Health and Sanitation, Sierra Leone. Forty-two candidates were assessed (Table 1) with 86% graded as “inadequate”, and the remainder having “identified the need for and commenced resuscitation”. Nobody performed “excellent resuscitation”. However almost everybody dried the baby immediately after birth, with only 3 candidates missing this step. 81% were unable to identify the need for resuscitation and 97% were unable to perform effective ventilation breaths on a manikin (Baby Anne, Laerdal). Not all candidates attempted cardiac massage; this is likely to be due to its non-inclusion in some training courses. 86% attempted chest compressions, but none were able to perform them adequately. The results of this assessment show that the ability of healthcare staff in Bo district to perform neonatal resuscitation is potentially very limited. The data are particularly important because of the high national neonatal mortality rate and because they were obtained from assessments carried out in obstetric/neonatal referral centres. Conflict of interest None of the authors have any conflict of interest to state. References 1. Surviving the first day. State of the world’s mothers 2013. London: Save the Children; 2013. http://www.savethechildrenweb.org/SOWM-2013/ 2. Opiyo N, Were F, Govedi F, et al. Effect of newborn resuscitation training on health worker practices in Pumwani Hospital, Kenya. PLoS ONE 2008;3:e1599. 3. Lee A, Cousens S, Wall S, et al. Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health 2011;11:S12. 4. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 1998;17:857–72.
e32
Letter to the Editor / Resuscitation 85 (2014) e31–e32
Niall Conroy ∗ Chernor S. Jalloh Louise Mitchell Anita Solanki Ahmed Seedat Stephen B. Lambert Bo Government Hospital, Bo District, Sierra Leone
∗ Corresponding
author. Tel.: +232 77623859. E-mail address: [email protected] (N. Conroy) 6 November 2013 7 November 2013
