Neonatal Resuscitation: Knowledge and Practices of Nurses and Midwives in Two Hospitals in Mogadishu, Somalia

Abstract

Introduction: Annually, 10 million of 136 million births worldwide need resuscitation. Despite improvement in maternal and child health indicators, the rate of neonatal mortality in Somalia is still high (39 in 1000 live births). Resuscitating babies effectively can reverse birth asphyxia, the main basis of neonatal mortality. Assessing knowledge and practices of nurses and midwives in neonatal resuscitation is important for policy makers with regards to needs. Study Objectives: To measure the knowledge level and practices of nurses and midwives on neonatal resuscitation at two hospitals offering maternity services in the Federal Republic of Somalia, and to evaluate hospital resources required for optimal newborn resuscitation. Methods: A cross-sectional study was carried out at Banadir maternity & children’s hospital and SOS hospital in Mogadishu. Nurses and midwives who had worked in the labour ward for at least one month were eligible while visiting ones were excluded. Forty consenting workers were randomly enrolled. The knowledge on neonatal resuscitation tools was developed based on the Neonatal Textbook of Resuscitation (2015) and WHO basic newborn resuscitation guidelines, while the practice tool was based on the WHO newborn resuscitation protocol observation checklist. Correctly answered items or practices were awarded one point. Hospital resources for neonatal resuscitation were assessed using a checklist derived from WHO newborn resuscitation protocol. Data Management and Analysis: SPSS version 23 was used to analyze data, and presented as frequencies and proportions for categorical data, means with standard deviation or median with interquartile range for continuous data. Knowledge on neonatal resuscitation was calculated as a percentage, and a score of <50% (poor), (50-74%) moderate and good (≥75%). Practices were graded as good for >75%, fair for 50-75%, poor for 40 - 49% and extremely poor for <40%. Hospital resources required for neonatal resuscitation were analyzed and classified using the WHO standard of classifying hospital equipment and supplies and presented using descriptive tables. Results: The median age was 24 years with most of the participants being female (92.5%). Degree holders (82.5%) accounted for the majority of participants while most of the participants were midwives (70.0%). On the years of experience, 52.5% had below 2 years of work experience while 42.5% had received refresher training. More than half of the participants, 57.5% (23/40) had poor knowledge levels about neonatal resuscitation, 27.5% (11/40) had moderate while 15.0% (6/40) had good knowledge levels. Of the 98 resuscitation observations made, 14 (14.3%) were good, 15 (15.3%) were fair, 36 (36.7%) were poor while 33 (33.7%) were very poor. Generally, regarding the availability of NBR equipment, Banadir had a compliance rate of 76.2% while SOS Hospital had a compliance rate of 42.9%. Conclusions and recommendations: Knowledge about newborn resuscitation was poor while the general practices of the nurses and midwives regarding newborn resuscitation were very poor. Both hospitals lacked functional essential basic neonatal resuscitation equipment. The hospitals need to provide regular newborn resuscitation training sessions to allow for better skill retention obtained and better practices towards newborn resuscitation.