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Table 3 Studies included in the review

From: Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

ReferenceResearch designSampleLocationFacility levelDevice usedQuality assessment
Abdulkadir et al. [19]Descriptive case studyMale newborn (1 h old) with idiopathic respiratory distress syndromeAhmadu Bello University Teaching Hospital (ABUTH), NigeriaTertiaryBubble CPAP system not describedPoor quality
Abdulkadir et al. [20]Descriptive case series of neonates who received nasal bubble CPAP20 spontaneously breathing newborns with respiratory distress over 1-year period from 1 June 2012 to 31 May 2013Ahmadu Bello University Teaching Hospital (ABUTH), NigeriaTertiaryImprovised water bottle systemFair quality
Amadi et al. [21]Quasi-experimental study comparing politeCPAP outcomes with standard care (improvised bubble CPAP system)57 neonates with RDS who met eligibility from three hospitals, dates unknownMultiple locations, NigeriaTertiaryLow-cost standalone system—politeCPAPPoor quality
Audu et al. [22]Descriptive case series of neonates who received nasal bubble CPAP48 babies admitted into newborn unit with respiratory distress over a 6-month period, dates unknownNational Hospital Abuja, NigeriaTertiaryImprovised water bottle systemFair quality
Brown et al. [23]Descriptive case studyA full-term neonate with respiratory distress caused by congenital pneumoniaQueen Elizabeth Central Hospital, MalawiTertiaryLow-cost standalone system—PumaniPoor quality
Crehan et al. [24]Quasi-experimental study comparing nurses’ assessments with new decision-aid with a paediatrician’s assessment57 neonates who received joint assessments by nurses and paediatrician, 27 April to 15 June 2015Zomba District Hospital, MalawiSecondaryLow-cost standalone system—PumaniPoor quality
Fulton and Lavalette [25]Pre and post study with follow-up 6 months after interventions introduced58 neonates in October 2012 and 55 neonates in February 2013Felege Hiwot Referral Hospital, EthiopiaTertiaryImprovised water bottle systemPoor quality
Gondwe et al. [26]Observational phenomenological study with in-depth semi-structured interviews12 caregivers of infants in Chatinkha nursery (0–28 days) and paediatric nursery (0–6 months) that improved on bCPAP January to February 2015Queen Elizabeth Central Hospital, MalawiTertiaryLow-cost standalone system—PumaniPoor quality
Kawaza et al. [5], Chen et al. [27]Quasi-experimental study with allocation to CPAP based on availability of equipment [5] with an economic evaluation [28]87 neonates (62 bCPAP and 25 nasal oxygen) over a 10 month period from January 2012 to October 2012Queen Elizabeth Central Hospital, MalawiTertiaryLow-cost standalone system—PumaniFair quality
McAdams et al. [29]Descriptive case series of neonates who received nasal bubble CPAP21 neonates starting < 3 days of age in NICU from January to June 2012Kiwoko Hospital, UgandaSecondary (rural referral hospital)Improvised water bottle systemFair quality
Myhre et al. [12]Pre and post introduction of bCPAP retrospective chart reviewAll preterm infants diagnosed with RDS consisting of 46 infants enrolled from 1 November 2007 to 30 April 2009 before and 72 infants enrolled from 1 November 2009 to 30 April 2011 after introduction of bCPAPAIC Kijabe Hospital, KenyaSecondary (rural referral hospital)Improvised water bottle systemFair quality
Nabwera et al. [30]Observational cross-sectional survey with a structured assessment tool and qualitative key informant interviews and focus group discussions39 neonates who received bubble CPAP between March and May 2017; 19 (of 23) tertiary level hospitals in Kenya surveyedMultiple locations, KenyaTertiary level hospitalsMajority (93%) used commercial bubble CPAP systemsFair quality
Nahimana et al. [31]Observational retrospective chart review of all newborns admitted to neonatal units in three rural hospitals43 infants initiated on bubble CPAP admitted between 1 February to 31 October 2013 (136 preterm and very low birthweight admitted overall)Butaro, Kirehe and Rwinkwavu District Hospitals, RwandaSecondary (rural district hospitals)Bubble CPAP system not describedFair quality
Ntigurirwa et al. [32]Pre and post clinical audits with follow-up 18 months after interventions introduced365 infants in the first 18 months of introduction between February 2012 and January 2014Two university hospitals and two district hospitals, RwandaTertiary and secondaryCommercial bubble CPAP system—Fisher PaykelFair quality
Okonkwo and Okolo [33]Observational cross-sectional survey administered to attendees during the 2015 Paediatric Association of Nigeria Conference (PANCONF)237 questionnaires returned by doctors and nurses54 health facilities from six geopolitical regions of NigeriaMostly public (87%) tertiary hospitals (76%)Improvised water bottle system vs commercial bubble CPAP system—Fisher PaykelPoor quality
Olayo et al. [28]Quasi-experimental study that compared knowledge and skill of first and second-generation health professionals trained37 (16 nurses, 21 physicians, medical/clinical officers) first-generation trained July 2014 to August 2015 and 40 (19 nurses, 21 physicians, medical/clinical officers) second generationMultiple locations, KenyaTertiaryCommercial bubble CPAP system—DeVilbiss IntelliPAPPoor quality
van den Heuvel et al. [34]Descriptive case series of neonates who received nasal bubble CPAP11 neonates during a 7-week introduction period from 11 March to 27 April 2008Queen Elizabeth Central Hospital, MalawiTertiaryImprovised water bottle systemFair quality