EFFECT OF NURSES TRAINING IN ESSENTIAL NEWBORN CARE ON REDUCING ASPHYXIA AND NEONATAL MORTALITY: A QUASI EXPERIMENTAL STUDY

Noreena Begum; Madiha Mukhtar; Azeem Kaleem

doi:10.46903/gjms/24.1.2117

EFFECT OF NURSES TRAINING IN ESSENTIAL NEWBORN CARE ON REDUCING ASPHYXIA AND NEONATAL MORTALITY: A QUASI EXPERIMENTAL STUDY

Noreena Begum, Madiha Mukhtar, Azeem Kaleem

Abstract

Background: Asphyxia and mortality remain significant concerns in developing countries, emphasizing the need for quality essential newborn care (ENC) at birth. Therefore, this study aimed to evaluate the effect of training nurses in Essential Newborn Care (ENC) on reducing neonatal asphyxia and mortality.

Materials & Methods: A quasi-experimental study design was conducted in the Obstetrics Department of a public teaching hospital in Lahore School of Nursing, The University of Lahore, Punjab, Pakistan. over a period of nine months. A total of 42 nurses were selected through census sampling and received an 8-week ENC training program focused on immediate newborn care and neonatal resuscitation. The prevalence of asphyxia and neonatal mortality among NICU admissions was assessed before and after the training. A validated questionnaire was used to evaluate nurses’ knowledge, practices, and neonatal outcomes. Data were analyzed using SPSS version 23.

Results: A review of 698 NICU admissions showed a slight decrease in asphyxia prevalence from 37.0% to 33.7%, with improvement in severity levels. Early neonatal mortality also showed a downward trend from 10.5% to 8.1%, though this change was not statistically significant. Secondary analysis Wilcoxon Signed-Rank test revealed significant improvements in nurses’ knowledge and practice scores post-training (p < 0.001), with median differences of 10.0 and 12.5, respectively.

Conclusion: The findings suggest that ENC training can contributes to improved neonatal outcomes. However, to achieve a significant reduction in asphyxia and mortality, additional factors influencing patient outcomes must be addressed.

Keywords

Asphyxia; Knowledge; Newborn; Neonatal mortality; Nurses; Practice.

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References

UNICEF WWBUN. Levels and trends child mortality - report 2023: estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. Washington; 2023 Mar.

Berhe YZ, Kebedom AG, Gebregziabher L, Assefa NE, Berhe LZ, Mohammednur SA, et al. Risk factors of birth asphyxia among neonates born in public hospitals of Tigray, Northern Ethiopia. Pediatr Health Med Ther. 2020;11:13–20. https://doi.org/10.2147/PHMT.S232633

Okyere FED. Incidence and associated factors of birth asphyxia in neonates admitted at St. Patrick’s Hospital, a district hospital in Ghana. OAlib. 2024;11(10):1–12. https://doi.org/10.4236/oalib.1111713

World Health Organization. Regional Office for the Western Pacific. Action plan for healthy newborn infants in the Western Pacific Region (2014–2020). Geneva: World Health Organization; 2014. 39 p.

Yosef T, Getachew D, Weldekidan F. Health professionals’ knowledge and practice of essential newborn care at public health facilities in Bench-Sheko Zone, southwest Ethiopia. Heliyon. 2021 Nov;7(11):e08369. https://doi.org/10.1016/j.heliyon.2021.e08369

Beletew B, Mengesha A, Wudu M, Abate M. Prevalence of neonatal hypothermia and its associated factors in East Africa: a systematic review and meta-analysis. BMC Pediatr. 2020 Dec 3;20(1):148. https://doi.org/10.1186/s12887-020-02046-1

Phoya F, Langton J, Dube Q, Iroh Tam PY. Association of neonatal hypothermia with morbidity and mortality in a tertiary hospital in Malawi. J Trop Pediatr. 2020 Oct 1;66(5):470–8. https://doi.org/10.1093/tropej/fmaa003

Latif S, Perveen K, Sarwar H, Khan S. The effect of educational program on nurses knowledge regarding physical assessment of cardiovascular system in tertiary hospital Lahore, Pakistan. Pak J Med Health Sci. 2022 Feb 26;16(2):252–4.

Eze CN, Elusoji CI, Okafor CN, Emeh AN, Obi IA, Odira CCH, et al. Impact of essential newborn care education on knowledge and practice of newborn care among nurses in rural primary health centres in Ebonyi state of Nigeria. Int J Community Med Public Health. 2023 Sep 30;10(10):3556–6. Available from: https://www.ijcmph.com/index.php/ijcmph/article/view/11643

Shikuku DN, Milimo B, Ayebare E, Gisore P, Nalwadda G. Practice and outcomes of neonatal resuscitation for newborns with birth asphyxia at Kakamega County General Hospital, Kenya: a direct observation study. BMC Pediatr. 2018 Dec 15;18(1):167. https://doi.org/10.1186/s12887-018-1155-3

American Academy of Pediatrics. Helping babies breathe: the golden minute. Learner workbook. Washington: American Academy of Pediatrics; 2010.

Nvonako H, Ojee E, Masika M, Brunelle A, Wamalwa D, Wasunna A. Effect of in-hospital training in newborn resuscitation on the competence of health-care workers in resuscitating newborn infants at birth at Mboppi Baptist Hospital, Douala, Cameroon. Pan Afr Med J. 2022;42. https://doi.org/10.11604/pamj.2022.42.236.32619

American Academy of Pediatrics. Helping babies breathe: the golden minute. Learner workbook. Washington: American Academy of Pediatrics; 2010.

Centers for Disease Control and Prevention. Data collection methods for program evaluation: observation. Eval Brief. 2008;16(16):1–2.

Polit DF, Beck CT. Nursing research: principles and methods. Philadelphia (PA): Lippincott Williams & Wilkins; 2004.

Bhandankar M. Impact of training health care workers in resuscitation on asphyxia related deaths. Acad J Pediatr Neonatol. 2022;11(4). https://doi.org/10.19080/AJPN.2022.11.555815

Amsalu R, Morris CN, Hynes M, Had HJ, Seriki JA, Meehan K, et al. Effectiveness of clinical training on improving essential newborn care practices in Bossaso, Somalia: a pre and post-intervention study. BMC Pediatr. 2020;20(1):215. https://doi.org/10.1186/s12887-020-02135-1

Milton R, Gillespie D, Dyer C, Taiyari K, Carvalho MJ, Thomson K, et al. Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study. Lancet Glob Health. 2022;10(5):e661–72. https://doi.org/10.1016/S2214-109X(22)00043-2

Ogunlesi TA, Ayeni VA, Ogunfowora OB, Jagun EO. The current pattern of facility-based perinatal and neonatal mortality in Sagamu, Nigeria. Afr Health Sci. 1970;19(4):3045–54. https://doi.org/10.4314/ahs.v19i4.31

Agudelo-Pérez S, Cifuentes-Serrano A, Ávila-Celis P, Oliveros H. Effect of the Helping Babies Breathe program on newborn outcomes: systematic review and meta-analysis. Medicina (B Aires). 2022;58(11):1567. https://doi.org/10.3390/medicina58111567

Tran HT, Mannava P, Murray JCS, Nguyen PTT, Tuyen LTM, Hoang Anh T, et al. Early essential newborn care is associated with reduced adverse neonatal outcomes in a tertiary hospital in Da Nang, Viet Nam: a pre-post intervention study. EClinicalMedicine. 2018;6:51–8. https://doi.org/10.1016/j.eclinm.2018.12.001

Dol J, Campbell-Yeo M, Murphy GT, Aston M, McMillan D, Richardson B. The impact of the Helping Babies Survive program on neonatal outcomes and health provider skills: a systematic review. JBI Database System Rev Implement Rep. 2018;16(3):701–37. https://doi.org/10.11124/JBISRIR-2017-003486

Nasim S, Kousar S, Latif W. Practices and outcomes of neonatal resuscitation for newborns with birth asphyxia in tertiary care hospitals in Lahore, Pakistan. Pak J Inten Care Med. 2025. https://doi.org/10.54112/pjicm.v5i01.49

Shukla VV, Carlo WA, Niermeyer S, Guinsburg R. Neonatal resuscitation from a global perspective. Semin Perinatol. 2022;46(6):151630. https://doi.org/10.1016/j.semperi.2022.151630

Panthee K, Sharma K, Kalakheti B, Thapa K. Clinical profile and outcome of asphyxiated newborn in a medical college teaching hospital. J Lumbini Med Coll. 2016;4(1):1. https://doi.org/10.22502/jlmc.v4i1.97

Simiyu IN, Mchaile DN, Katsongeri K, Philemon RN, Msuya SE. Prevalence, severity and early outcomes of hypoxic ischemic encephalopathy among newborns at a tertiary hospital, in northern Tanzania. BMC Pediatr. 2017;17(1):131. https://doi.org/10.1186/s12887-017-0886-9

Uleanya ND, Aniwada EC, Ekwochi U, Uleanya ND. Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria. Afr Health Sci. 2019;19(1):1554. https://doi.org/10.4314/ahs.v19i1.31

Woday A, Muluneh A, St Denis C. Birth asphyxia and its associated factors among newborns in public hospital, northeast Amhara, Ethiopia. PLoS One. 2019;14(12):e0226891. https://doi.org/10.1371/journal.pone.0226891

Huang C, Hu L, He J, Luo B. Effects of early essential newborn care versus routine birth care on physiological variables and sleep state among newborn infants: a quasi-experimental design. BMC Pediatr. 2022;22(1):127. https://doi.org/10.1186/s12887-022-03146-3

Briggs DC, Eneh AU, Alikor EAD. Basic neonatal resuscitation: retention of knowledge and skills of primary health care workers in Port Harcourt, Rivers State, southern Nigeria. Pan Afr Med J. 2021;38. https://doi.org/10.11604/pamj.2021.38.248.27791

DOI: https://doi.org/10.46903/gjms/24.1.2117