Implementation of bCPAP to Improve Neonatal Outcomes in Malawi: Interim Results

Session: Clinical Interventions for Newborn Health: Improving the Odds for Survival

Presenter: Rebecca Richards-Kortum, Rice 360° Institute for Global Health Technologies

Background: Over the past two years, low-cost bubble CPAP was implemented at 18 government district and central hospitals in Malawi to improve neonatal survival.

Methodology: Implementation was carried out in three phases: the first phase included 4 central and 4 district hospitals, the second phase included 10 district hospitals, and the ongoing third phase will include the remaining 10 district hospitals. At each hospital, staff in the maternity and nursery wards were trained to use bCPAP and bCPAP machines were installed with ancillary technology, such as an oxygen concentrator, suction machine, and all necessary consumables. In the months following implementation, demographic and outcome data were collected for all neonates treated with bCPAP and compared to rates observed in a previous pilot study to implement bCPAP at Queen Elizabeth Central Hospital (QECH) in Malawi.  Outcomes were stratified by demographic factors, including patient admission temperature, admission weight, and diagnosis.

Results: To date, 879 neonates weighing ≥ 1 kg have received bCPAP.  The survival rate for phase 1 hospitals was 48%, lower than the 71% survival rate observed in the initial pilot evaluation at QECH.  Median admission temperatures were significantly higher for non-hyperthermic infants who survived to discharge than for those who did not in the pilot (36 °C vs 35.2 °C, p=0.021) and phase 1 (35.5 °C vs 35 °C, p=0.002) studies.  Moreover, the prevalence of moderate and severe hypothermia on admission was higher in phase 1 (25%) than in the pilot study (0%). In response, training was strengthened to emphasize thermal care and additional equipment was provided to strengthen warming capacity.  To date, the survival rate for phase 2 hospitals is 55%.

Conclusions: Results suggest that admission hypothermia is a critical factor in patient survival on bCPAP.