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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

Reference

Research design

Sample

Location

Facility level

Device used

Quality assessment

Abdulkadir et al. [19]

Descriptive case study

Male newborn (1 h old) with idiopathic respiratory distress syndrome

Ahmadu Bello University Teaching Hospital (ABUTH), Nigeria

Tertiary

Bubble CPAP system not described

Poor quality

Abdulkadir et al. [20]

Descriptive case series of neonates who received nasal bubble CPAP

20 spontaneously breathing newborns with respiratory distress over 1-year period from 1 June 2012 to 31 May 2013

Ahmadu Bello University Teaching Hospital (ABUTH), Nigeria

Tertiary

Improvised water bottle system

Fair 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 unknown

Multiple locations, Nigeria

Tertiary

Low-cost standalone system—politeCPAP

Poor quality

Audu et al. [22]

Descriptive case series of neonates who received nasal bubble CPAP

48 babies admitted into newborn unit with respiratory distress over a 6-month period, dates unknown

National Hospital Abuja, Nigeria

Tertiary

Improvised water bottle system

Fair quality

Brown et al. [23]

Descriptive case study

A full-term neonate with respiratory distress caused by congenital pneumonia

Queen Elizabeth Central Hospital, Malawi

Tertiary

Low-cost standalone system—Pumani

Poor quality

Crehan et al. [24]

Quasi-experimental study comparing nurses’ assessments with new decision-aid with a paediatrician’s assessment

57 neonates who received joint assessments by nurses and paediatrician, 27 April to 15 June 2015

Zomba District Hospital, Malawi

Secondary

Low-cost standalone system—Pumani

Poor quality

Fulton and Lavalette [25]

Pre and post study with follow-up 6 months after interventions introduced

58 neonates in October 2012 and 55 neonates in February 2013

Felege Hiwot Referral Hospital, Ethiopia

Tertiary

Improvised water bottle system

Poor quality

Gondwe et al. [26]

Observational phenomenological study with in-depth semi-structured interviews

12 caregivers of infants in Chatinkha nursery (0–28 days) and paediatric nursery (0–6 months) that improved on bCPAP January to February 2015

Queen Elizabeth Central Hospital, Malawi

Tertiary

Low-cost standalone system—Pumani

Poor 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 2012

Queen Elizabeth Central Hospital, Malawi

Tertiary

Low-cost standalone system—Pumani

Fair quality

McAdams et al. [29]

Descriptive case series of neonates who received nasal bubble CPAP

21 neonates starting < 3 days of age in NICU from January to June 2012

Kiwoko Hospital, Uganda

Secondary (rural referral hospital)

Improvised water bottle system

Fair quality

Myhre et al. [12]

Pre and post introduction of bCPAP retrospective chart review

All 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 bCPAP

AIC Kijabe Hospital, Kenya

Secondary (rural referral hospital)

Improvised water bottle system

Fair quality

Nabwera et al. [30]

Observational cross-sectional survey with a structured assessment tool and qualitative key informant interviews and focus group discussions

39 neonates who received bubble CPAP between March and May 2017; 19 (of 23) tertiary level hospitals in Kenya surveyed

Multiple locations, Kenya

Tertiary level hospitals

Majority (93%) used commercial bubble CPAP systems

Fair quality

Nahimana et al. [31]

Observational retrospective chart review of all newborns admitted to neonatal units in three rural hospitals

43 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, Rwanda

Secondary (rural district hospitals)

Bubble CPAP system not described

Fair quality

Ntigurirwa et al. [32]

Pre and post clinical audits with follow-up 18 months after interventions introduced

365 infants in the first 18 months of introduction between February 2012 and January 2014

Two university hospitals and two district hospitals, Rwanda

Tertiary and secondary

Commercial bubble CPAP system—Fisher Paykel

Fair 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 nurses

54 health facilities from six geopolitical regions of Nigeria

Mostly public (87%) tertiary hospitals (76%)

Improvised water bottle system vs commercial bubble CPAP system—Fisher Paykel

Poor quality

Olayo et al. [28]

Quasi-experimental study that compared knowledge and skill of first and second-generation health professionals trained

37 (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 generation

Multiple locations, Kenya

Tertiary

Commercial bubble CPAP system—DeVilbiss IntelliPAP

Poor quality

van den Heuvel et al. [34]

Descriptive case series of neonates who received nasal bubble CPAP

11 neonates during a 7-week introduction period from 11 March to 27 April 2008

Queen Elizabeth Central Hospital, Malawi

Tertiary

Improvised water bottle system

Fair quality