Date of Award

2017

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Susan D. Newman

Second Advisor

Charlene Pope

Third Advisor

Kathleen B. Cartmell

Fourth Advisor

Shahirose Premji

Abstract

Purpose: Sub-Saharan Africa has the highest neonatal mortality rates in the world. The World Health Organization (WHO) recognizes disparities in care as a contributing factor to neonatal mortality in low-and middle-income countries (LMIC). The WHO has therefore incorporated maternal and newborn care educational programs for Maternal Child Health (MCH) providers. This dissertation includes research that will guide the development of future educational interventions regarding neonatal airway management, tailored to the learning needs of midwives and Traditional Birth Attendants (TBAs) in rural Uganda. Problem: There is an urgent need to provide neonatal resuscitation education and to build clinical capacity in LMIC, where access to health care is poor, particularly in rural areas. The burden of neonatal mortality and long term impairment due to hypoxic brain damage can significantly affect the population. Gap: The WHO has developed programs to address neonatal airway management, which are geared towards physicians, nurses and midwives. Although trained health care workers play an essential role in decreasing the neonatal mortality rate, the limited numbers of formally trained providers are unable to cover rural areas. Therefore, TBAs, who are not formally trained, are an integral part of the maternal-child- healthcare (MCH) and, remain the primary healthcare providers in the rural areas of LMIC. Aim: To review the literature for effectiveness of the educational interventions for neonatal airway management in LMIC. To explore the perceptions of midwives and TBAs practicing in rural Uganda related to: (a) facilitators of and barriers to neonatal airway management and (b) their learning preferences to inform the development of a culturally appropriate neonatal airway management program for better adaptation in local context. Design/Findings: This dissertation consists of three manuscripts that address neonatal airway management in LMIC. The first manuscript reviewed 10 original studies of MCH care programs to identify effective components for, and the dissemination process of, educational interventions for neonatal resuscitation among TBAs. The second manuscript reviewed instruments that are available to measure provider self-efficacy for performing neonatal resuscitation. The third manuscript describes a study, using the focused ethnographic methodological approach and feminist perspective to explore factors affecting neonatal airway management by TBAs, and the need and preferences for educational resources to improve TBAs airway management practices. The findings of all three manuscripts informed the future development of culturally tailored educational intervention using “time honored” teaching methods according to the learning preferences of the TBAs. These educational interventions will be geared towards providing adequate competency and confidence for TBAs to perform neonatal airway management

Rights

All rights reserved. Copyright is held by the author.

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