Neonatal resuscitation: an observational study assessing the readiness of service providers in Nepal

A significant proportion of neonatal mortality, a major public health challenge in low- and middle-income countries, can be attributed to intrapartum-related hypoxic events. This study seeks to assess the determinants of health care providers competence in providing newborn resuscitation. A cross-sectional survey of 154 health facilities in Nepal was done. This nested study evaluated the newborn resuscitation knowledge and skills of 462 health care providers by individually assessing a delivery using a 22-item clinical practice observation tool and administering the standard 18-item Helping Babies Breathe Knowledge Check Significant predictors of provider knowledge included: province (0.085 points higher in Bagmati province, p=0.018); mean availability of essential utilities and resuscitation aids (0.173 points, p<0.001 and 0.187, p= 0.02 respectively); participation in - Latter-day Saint Charities - Safa Sunaulo Nepal (LDSC/SSN) newborn resuscitation training, scale-up and skill retention program (0.676 units higher, p<0.001); and qualifications (0.136 points higher among health providers with Bachelor of Nursing degree, p<0.001, 0.072 points higher among providers with Masters in Nursing degree, p= 0.010 and 0.110 units higher among providers with Senior Auxiliary Nursing Midwife degree,, p=0.001). Significant factors associated with resuscitation skill included province (0.056 units higher in province 1, p= 0.015 and 0.037 units higher in Sudurpaschim province, p=0.034); delivery caseload (0.066 units higher mean skill score in health facilities with average monthly delivery of more than 120, p= 0.011); availability of newborn resuscitation practice aids (0.093 units higher score in health facilities with resuscitation practice aids, p= 0.008); and participation in LDSC/SSN newborn resuscitation training, scale-up and skill retention program (0.968 units, p< 0.001). Participation in the LDSC/SSN skill retention program was the best predictor of newborn resuscitation knowledge and skills. The LDSC/SSN model of newborn resuscitation training, scale up and skill retention could be one potential cost-effective model to address gaps in resuscitation knowledge and skills among service providers.