Assessment of health care workers` competence in basic newborn resuscitation at Sub County Hospitals in Uasin Gishu, Kenya

Abstract

Background: The neonatal period presents the highest risk of death among the under-fives. Uasin Gishu County has a neonatal mortality rate of 52/1000 live births, much higher than the national mortality rate of 22/1000 live births. One of the major causes of neonatal deaths is birth asphyxia. Up to a third of neonatal deaths can be averted by performing facility based basic neonatal resuscitation which entails stimulation at birth and assisted ventilation with bag and a mask. Delay in establishing ventilation for non-breathing infant leads to hypoxia events that contribute to neonatal mortality and morbidity. The success of new-born resuscitation depends on knowledge, skills of the health care workers and the availability of the equipment. Objective: To assess the health care workers’ competence in basic new-born resuscitation at Sub County Hospitals in Uasin Gishu County Study Methods: This was a cross sectional study conducted in the six Sub County Hospitals in Uasin Gishu County between January and June 2016. A census was done of all the health care workers in the labour wards. Data on socio-demographic characteristics were collected using a structured questionnaire. Knowledge on basic new born resuscitation was assessed using questions adapted from Neonatal Textbook of Resuscitation 6th Edition (2015). Skills assessment was based on clinical simulations adapted from Emergency Triage Assessment and Treatment plus admission care (ETAT+) course. Factors associated with skills and knowledge were also determined. Equipment was marked against a checklist. Data were analyzed using STATA Software Version 14.Descriptive statistics were used for continuous variables and categorical variables were presented in tables and graphs. Chi square test and Fishers Exact test were used to test for association between categorical variables. A p-value of <0.05 was considered significant. Results: A total of 46 out of 57(80.7%) health care workers from the six sub county hospitals were assessed. Majority were registered nurses 38(82.6%) and 15(39%) had worked in the labour ward for more than five years. Twenty one (45.7%) health care workers had received in-service training on new-born resuscitation, with 18(85.7%) trained on Basic Emergency Obstetric and Neonatal Care (BEmONC). On their knowledge performance, 21(46%) health care workers passed while the rest failed. The following steps of resuscitation were achieved by the number of health care workers indicated; Dry baby 30(71.4%), Assess Airway 24(57.1%) Assess Breathing 14(33.3%), Call for Help 4(9.6%), Effective ventilation 2(4.8%). None of them achieved all the mentioned steps of basic new-born resuscitation hence comparative statistical analysis was not done. There was no significant association between knowledge and years of experience, cadre and in service training (P value, 0.519, 0.411, 0.979) respectively. The following equipment was available in all the hospitals; self-inflating bag, face mask size 1, bulb sucker and radiant warmer. Conclusion: Health care workers do not have skills on basic new-born resuscitation in as much half of them have the minimum competency level of knowledge. The sub-county hospitals are well equipped for basic new-born resuscitation. Recommendation: There is need to improve the health care workers resuscitation competency in Uasin Gishu County to acceptable levels.