Affordable Access

Publisher Website

'Sometimes you are forced to play God…': a qualitative study of healthcare worker experiences of using continuous positive airway pressure in newborn care in Kenya.

  • Nabwera, Helen M1
  • Wright, Jemma L2
  • Patil, Manasi3
  • Dickinson, Fiona3
  • Godia, Pamela4
  • Maua, Judith4
  • Sammy, Mercy K5
  • Naimoi, Bridget C6
  • Warfa, Osman H7
  • Dewez, Juan Emmanuel8
  • Murila, Florence9
  • Manu, Alexander3
  • Smith, Helen10
  • Mathai, Matthews3
  • 1 International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK [email protected]
  • 2 Paediatrics Department, Betsi Cadwaladr CHC, Wrexham, UK.
  • 3 International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
  • 4 International Public Health, Liverpool School of Tropical Medicine, Nairobi, Kenya. , (Kenya)
  • 5 General Paediatrics, Gertrude's Garden Children's Hospital, Nairobi, Kenya. , (Kenya)
  • 6 Child Health, AMPATH Kenya, Eldoret, Kenya. , (Kenya)
  • 7 Neonatal, Child and Adolescent Health, Kenya Ministry of Health, Nairobi, Kenya. , (Kenya)
  • 8 Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
  • 9 Paediatrics and Child Health, University of Nairobi School of Medicine, Nairobi, Kenya. , (Kenya)
  • 10 Maternal and Newborn Health, International Health Consulting Services Ltd, Liverpool, UK.
Published Article
BMJ Open
Publication Date
Aug 13, 2020
DOI: 10.1136/bmjopen-2019-034668
PMID: 32792424


​OBJECTIVE: To explore the experiences of using continuous positive airway pressure (CPAP) in newborn care among healthcare workers in Kenya, and to identify factors that would promote successful scale-up. ​DESIGN AND SETTING: A qualitative study using key informant interviews and focus group discussions, based at secondary and tertiary level hospitals in Kenya. ​PARTICIPANTS: Healthcare workers in the newborn units providing CPAP. ​PRIMARY AND SECONDARY OUTCOME MEASURE: Facilitators and barriers of CPAP use in newborn care in Kenya. ​RESULTS: 16 key informant interviews and 15 focus group discussions were conducted across 19 hospitals from September 2017 to February 2018. Main barriers reported were: (1) inadequate infrastructure to support the effective delivery of CPAP, (2) shortage of skilled staff rendering it difficult for the available staff to initiate or monitor infants on CPAP and (3) inadequate knowledge and training of staff that inhibited the safe care of infants on CPAP. Key facilitators reported were positive patient outcomes after CPAP use that increased staff confidence and partnership with caregivers in the management of newborns on CPAP. Healthcare workers in private/mission hospitals had more positive experiences of using CPAP in newborn care as the relevant support and infrastructure were available. ​CONCLUSION: CPAP use in newborn care is valued by healthcare workers in Kenya. However, we identified key challenges that threaten its safe use and sustainability. Further scale-up of CPAP in newborn care should ensure that staff members have ready access to optimal training on CPAP and that there are enough resources and infrastructure to support its use. ETHICS: This study was approved through the appropriate ethics committees in Kenya and the UK (see in text) with written informed consent for each participant. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Report this publication


Seen <100 times