475 - Implementation of a Battery-operated Heart Rate Meter for Newborn Resuscitation: Perceptions and Experiences of Midwives in the Democratic Republic of the Congo

Poster Number: 475
Publication Number: 475.230

Madeline Thornton, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Daniel Ishoso, Université of Kinshasa, Kinshasa, Kinshasa, Congo, (Congo – Kinshasa); Adrien Lokangaka, Kinshasa School of Public Health, Kinshasa, Kinshasa, Congo, (Congo – Kinshasa); Sara Berkelhamer, University of Washington School of Medicine, Seattle, WA, United States; Beena D. Kamath-Rayne, American Academy of Pediatrics, Barrington, IL, United States; Janna Patterson, American Academy of Pediatrics, Itasca, IL, United States; Melissa Bauserman, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Carl Bose, University of North Carolina at Chapel Hill School of Medicine, Pittsboro, NC, United States; Jackie Patterson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: 900,000 newborns die from respiratory depression each year; nearly all of these deaths occur in low- and middle-income countries (LMICs). Deaths from respiratory depression are reduced by evidence-based resuscitation. Electronic heart rate monitoring provides a sensitive indicator of the neonate’s status to inform evidence-based resuscitation, but is infrequently used in LMICs.

Objective: In a recent trial in the Democratic Republic of the Congo, midwives used a low-cost, battery-operated heart rate meter (NeoBeat) to continuously monitor heart rate during resuscitations. We explored midwives’ perceptions of NeoBeat, including its utility and barriers and facilitators to use.

Design/Methods: After an 18-month intervention in which midwives used NeoBeat during resuscitations, we surveyed midwives regarding their use of NeoBeat. We also conducted three focus group discussions (FGDs) regarding the incorporation of NeoBeat into clinical care. All FGDs occurred in Lingala, the native language. We transcribed audio-recordings and then translated transcriptions from Lingala to French to English. We analyzed data using the qualitative content analysis method involving the following steps: 1) coding of transcripts using Nvivo software, 2) comparison of codes to identify patterns in the data, and 3) grouping of codes into categories by two independent reviewers, with final categories determined by consensus.

Results: Among 30 surveyed midwives, 100% thought NeoBeat had changed the way they resuscitate newborns a great deal; 93% strongly agreed they wanted to continue using NeoBeat in clinical practice. From the FGDs with 30 midwives, we identified five main categories of perceptions and experiences regarding the use of NeoBeat: 1) Providers’ initial skepticism evolved into pride and a belief that NeoBeat was essential to resuscitation care, 2) Providers viewed NeoBeat as enabling their resuscitation and increasing their capacity, 3) NeoBeat helped providers identify flaccid newborns as liveborn, leading to hope and the perception of saving of lives, 4) Cleaning and charging NeoBeat as well as an insufficient quantity of the devices were challenges of use, and 5) Providers desired to continue using the device and to expand its use beyond resuscitation and their own facilities.Conclusion(s): Midwives perceived that NeoBeat enabled their resuscitation practices, including assisting them in identifying non-breathing newborns as liveborn. Increasing the quantity of devices per facility and developing systems to facilitate cleaning and charging may be critical for scale-up.
Madeline Thornton CVMadeline Thornton CV 12-2021.pdf
Table 2. Categories and exemplary quotes from midwives