The study was conducted at Asella Referral and Teaching Hospital, a tertiary hospital located in Asella town, which is 175 km south of the capital city, Addis Ababa. It serves as a referral center for about 3.5 million people in the surrounding districts. The neonatal intensive care unit and delivery units are the busiest wards of the hospital, with the highest admission rate, providing care for newborn babies born in the hospital and referred from other health facilities. These units are run by a team of pediatricians, gynecologists and obstetricians, pediatric residents, GYN-OBS residents, medical interns, unit nurses, and midwives.
Study Design and Period
An institutional-based cross-sectional survey was conducted on assessment of knowledge on neonatal resuscitation and associated factors among Health Professionals working in the delivery and neonatal intensive care unit of Asella Referral and Teaching Hospital from April 1 to May 30, 2023.
Study population/Subjects
The study targeted all Health Professionals (Nurses, midwives, Medical Interns, Pediatric and GYN-OBS Residents) working in Delivery and neonatal intensive care unit. The Study subjects were selected purposely because they are directly engaged in neonatal resuscitation and the procedure is mainly performed in the NICU and delivery room.
Inclusion and Exclusion criteria
All Health Professionals working in the delivery ward and NICU who were available during data collection time and those who gave informed consent were included. Whereas; those individuals with incomplete questionnaires, were inaccessible during data collection time due to illness or annual leave, and who refuses to participate in the study were not included.
Sampling size Determination and procedure
Since the target populations were relatively small in size, and the sampling frame was complete, the researchers adopted the Census/Survey approach to select the respondents. This means all Study subjects who fit the inclusion criteria were enrolled in the study, which is 231 health professionals working in the delivery ward and NICU. The single population proportion formula was used to estimate the sample size by using the proportion of knowledge level of health professionals taken from the previous study(19), which was 43.2%. After correctional formula was used and addition of 15% for non-response rate, the final sample size become 170, which is less than our Study population (231). So, all study participants were enrolled.
Study variables
Dependent variables: Knowledge Level towards Neonatal Resuscitation
Independent variables: (1). Providers related factors: Sex, Age, Profession, Level of education, Neonatal Resuscitation Training, Work experiences, and Attitude of the Participants towards Neonatal Resuscitation. (2). Institutional related factors: Working unit, Availability of resuscitation equipment, Availability of resuscitation guideline, Supportive supervision, and Work load.
Data collection tools
A structured English questionnaires were used to collect data, which was carefully developed by reviewing various sources, including literature(20), WHO guidelines(21), 2015 American Heart Association guidelines(22), Help Babies Breath (HBB) 2nd edition knowledge assessments(2). The tool consists of four sections addressing; 1). Socio-demographic/ provider-related factors, 2). Questions addressing the Attitude or perceptions of participants about neonatal resuscitation, 3). Institutional related factors, 4). thirty-one Multiple choice questions addressing the knowledge of Health Professionals towards neonatal resuscitation.
Eight health professionals collected the data under the supervision of the principal investigator. They received three days of training to ensure they understood the study’s objectives, terminology, assessment tools, and ethical considerations. The questionnaires were personally administered to health professionals while they were on duty in labor wards and neonatal intensive care units. Participants had 25-30 minutes to complete the questionnaires, with at least one data collector present to ensure they didn’t refer to textbooks or online resources. After participants finished, we checked the completeness of each questionnaire. The data collection took place over a two-month period, from April 1 to May 30, 2023.
Data quality control
The data collection tool underwent rigorous validation by subject matter specialists, including neonatologists, pediatricians, nurses, midwives specialized in neonatology care, and researchers with related publications. The Experts assessed each variable’s alignment with the study’s objectives, and the content validity index of the tool was calculated and rated at 0.849. Furthermore, a pre-test was conducted on 5% of study subjects on a similar population in other institutions. Based on the pretest results, adjustments were made by the principal investigator to enhance the tool’s clarity, understandability, and simplicity before actual data collection time. The collected data were reviewed and checked for completeness, clarity, and consistency daily.
Measurement of Knowledge
Health professionals’ knowledge levels regarding neonatal resuscitation were assessed using a 31-item multiple-choice questionnaire. Correct answers were assigned one point, while incorrect responses received zero points. Participants were subsequently categorized into two groups based on their total scores: those with good knowledge (scoring 80% or higher) and those with poor knowledge (scoring less than 80%). This categorization has been employed in various studies, considering both the overall cumulative mean score and cumulative mean percentage (13,19,20,23–25).
Data processing and analysis
The data was verified, coded, and entered into Epi Data 4.6 Software and then exported into SPSS version 26 Software for analysis. Descriptive statistics, including frequency, percentage, and mean, were used to describe the analysis results. Additionally, binary logistic regression was employed to explore the association between knowledge and each independent variable. Variables with a significance level (p-value) of ≤ 0.25 in bivariate analysis were considered candidates for multivariable logistic regression to identify associated factors related to good knowledge. The model’s fitness was assessed using Hosmer-Lemeshow statistics and Omnibus tests, with an acceptable fit observed (p-value = 0.65). Finally, odds ratios with 95% confidence intervals were used to measure the direction and strength of statistical associations, with a p-value < 0.05 indicating a statistically significant association with the outcome.
Operational Definition
Neonatal resuscitation: Intervention after birth to 28 days of the baby to assist in breathing and circulation.
Health professionals: In this study refers to midwives, nurses, medical interns and residents working in the delivery ward, NICU, and pediatric ward.
Midwives: a health professional who worked in the Obs-gyn wards, and cares for mother and newborns around birth.
Nurses: a health professional who worked in the pediatric department or in NICU.
Medical interns: Final-year medical students gaining practical experience in major hospital wards, including pediatrics, medicine, obstetrics-gynecology, and surgery.
Residents: Physicians undergoing postgraduate study or specialized practice in Obstetrics-Gynecology and pediatric departments.
Knowledge: the knowledge level of health professionals was reported as, good knowledge: for those who scored 80% or higher (>=25 correct response from 31 questions) and Poor knowledge: for those who scored below 80% (<25 correct response from 31 questions)(19,24).
Attitude: Participants with score of greater than the mean score was considered having good perception and those who scored less than the mean score was considered having poor perception toward neonatal resuscitation(15,16,20).
Full equipment for resuscitation: Hospitals with the minimum of the following materials according WHO 2016 Technical Specifications of Neonatal Resuscitation Devices (TSNRD): Radiant warmer, bag with mask, suction machine & catheter, single/multi use suction bulb, stethoscope(26).
Work load: Health professionals who serve for more than 5 neonates/24 hours and/or who works for more than 8 hours/24hours according to Ethiopian pediatric society(27).