GARDEN CITY UNIVERSITY COLLEGE, KENYASE -

KUMASI
FACULTY OF HEALTH SCIENCES
DEPARTMENT OF NURSING/MIDWIFERY

Research Proposal by
Samuel Annor Ampadu – 04326919
And
Vivian Asamoah – 04327019

April 2020
Topic:

PRACTICE OF NEONATAL RESUSCITATION AMONG

MIDWIVES: A STUDY AT KWAHU GOVERNMENT

HOSPITAL
 1.0 INTRODUCTION

• Background of the study

• Generally, newborn birth is a natural transition from the
intrauterine to extra uterine life for all babies. About 90% of
newborn babies need no medical intervention for survival, whiles
5-10% needs some form of resuscitation (Palme-Kilander, Tunell
& Chiwei, 2003).

• Asphyxia is a life-threatening condition in which oxygen is

prevented from reaching the tissues by obstruction of or damage
to any part of the respiratory system (Martin, 2008).
Background of the study cont.

• According to WHO, lack of commitment and attention given

to newborns at birth accounted for 2.7 million deaths,
approximately 45% of under- five deaths globally occurred
during their first month of life in 2015 (WHO, 2016).
 1.2 PROBLEM STATEMENT
• Globally, millions of babies are born annually of which majority
(90%) are able to perform their cardiopulmonary activities
independently and spontaneously but the remaining 10% of
newborns requires some assistance to begin breathing at birth and
1% or more may require intensive resuscitation effort (Wiswell,
2003).

• At an under five mortality rate of 82 deaths per 1000 live births,

Ghana was unable to meet the MDG 4 target of 41 deaths per 1000
live births by the year 2015.
 PROBLEM STATEMENT CONT.

• Statistical records from Kwahu Government hospital in the Eastern

Region of Ghana indicate birth asphyxia as the top cause of
neonatal death as follows birth asphyxia 14 (40%), 22 (45.8%) and
19 (40%) in 2017, 2018 and 2019 respectively.

• This data shows that birth asphyxia accounted for majority of the
causes of neonatal mortality in the years under review and
improved knowledge and practice on neonatal resuscitation will
enhance the survival rate of these new born babies.
 PROBLEM STATEMENT CONT.

• Unfortunately, there is paucity of literature on midwives knowledge

and practice of neonatal resuscitation in Kwahu Government
Hospital which could inform authorities/management as to the best
approach to curb asphyxia related neonatal deaths.
 Conceptual Framework
Knowledge Practice

Able to use equipment Available Equipment

Knowledge on Practice of
Neonatal Neonatal
Resuscitation Resuscitation

Neonatal Resuscitation Available

protocols
Skilled/Experienced Staff

Able to perform
Neonatal Resuscitation
1.3 GENERAL OBJECTIVE

The general objective of the study is to assess the practice on

neonatal resuscitation among midwives.

1.3 SPECIFIC OBJECTIVES

1. To identify challenges faced by midwives in performing

neonatal resuscitation.

2. To find out the association between knowledge and practice

of midwives on neonatal resuscitation

3. To assess midwives practice using the neonatal resuscitation

protocols.
 1.4 OPERATIONAL DEFINITION OF TERMS
• Birth asphyxia – Failure of the new born to initiate and sustain
breathing at birth.

• Resuscitation – Restoration to life of a baby having breathing

problems or showing no signs of breathing.

• Infant mortality rate – Number of deaths during the first year of

life per 1000 lives births in a given year or period.

• Low birth weight – Birth weight of less than 2000g (2kg),

irrespective of gestational age.

• New born – A baby who has just been delivered.

 LITERATURE REVIEW

OVERVIEW
• This section of the research gives insight to neonatal resuscitation
practices, which is supported by previous studies by different
researchers, as well as other literature available on neonatal
resuscitation.
• Neonatal resuscitation is defined as the set of interventions at the
time of birth to support the establishment of breathing and
circulation. Each year approximately 10 million babies do not
breathe immediately at birth, of which about 6 million require
basic neonatal resuscitation. The major burden is in low-income
settings, where health system capacity to provide neonatal
resuscitation is inadequate.
 CHALLENGES FACED BY MIDWIVES IN PRACTICING
NEONATAL RESUSCITATION

• In a study that was conducted to highlight the ergonomic challenges

inherent in neonatal resuscitation, space to operate was in most hospitals
becomes too small. Beyond the limitations of the space around the
patient’s bed, neonatal resuscitation is further impacted in many
hospitals by the lack of sufficient physical space allocated to neonatal
care in the typical labor and delivery or operative delivery rooms

• In neonatal resuscitation, common challenges might include summoning

the neonatal resuscitation team to the delivery room and the
communication of vital information between and within
multidisciplinary teams
 MIDWIVES PRACTICING NEONATAL RESUSCITATION
USING PROTOCOLS

• Several guidelines/protocols including the European

Resuscitation Council Guidelines for Resuscitation 2015 and
2015 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science have
been developed to ensure effective transition of the new born
after delivery (Wyllie et al., 2015; Jonathan Wyllie et al., 2015).
Evidence suggest midwives in the developed countries such as
UK practice evidence based neonatal resuscitation with
favourable response (Mann et al., 2012).
 MIDWIVES PRACTICING NEONATAL RESUSCITATION
USING PROTOCOLS CONT.

• Essentially, some midwives attribute their poor performance to

inadequate knowledge and skills resulting from lack of practical
training (in-service training) (Gross, Avis, Gustafson, Dudovitz,
& Rickard, 2015; Khalid et al., 2015; Mathai et al., 2015).
• In a study that was conducted to assess the extent of knowledge
and practice towards neonatal resuscitation among nurses and
midwives in public hospitals of south Wollo northeast Ethiopia,
Institutional based cross-sectional study design was employed
among 143 study participants selected by a simple random
sampling method from each hospital.
 MIDWIVES PRACTICING NEONATAL RESUSCITATION
USING PROTOCOLS CONT.

• Self-administered questionnaire and interview-based guide were

used to collect data. Findings depicted that; majority of the
participants (75.5%) had poor practice towards neonatal
resuscitation. Among the different steps of neonatal resuscitation,
the correct response given by the participants was more than 80%
for only 10 of 30 practice questions
 METHODOLOGY
• BACKGROUND

• This section explains the methods that would be used during the
research work. It enlightens how the study would be done, where
and what would be studied.
• THE STUDY AREA AND POPULATION

• The study will be conducted at the Kwahu Government Hospital in

the Eastern region of Ghana. The target population for the study
will include all Registered Midwives who have worked for at least
one year in the Kwahu Government Hospital.
 SAMPLING TECHNIQUES AND STUDY DESIGN

• Quantitative research method in line with the design a cross-

sectional descriptive study will be used. Convenience sampling
method will be used in selecting all Registered Midwives working
at the Kwahu Government Hospital for at least one year.
• DATA COLLECTION TOOL AND PROCEDURE

• The main research instrument will be questionnaires. The

questionnaire will be grouped in categories to collect data on the
knowledge, attitude and practice of midwives on neonatal
resuscitation.
 DATA ANALYSIS

• The data collected will be edited, sorted, and coded. EPI and
Microsoft word will be used to analyze the data.

• ETHICAL CONSIDERATION

• Prior to conducting this study, administrative approval will be

sought from the Committee of Human Right, Publication and
Ethics (CHRPE), GCUC and letter of introduction from
Department of Midwifery GCUC will be issued to the District
Director of Health Services and the medical superintendent of
Kwahu Government Hospital (KGH).
 ETHICAL CONSIDERATION CONT.

• Additionally, the names of the participants as well as other details

that will lead to easy identification of the participants will be
excluded from the data collection tool to maintain their
anonymity. Participants will not be coaxed/forced to be part of the
study neither will they be prevented from withdrawing from the
study as they wish.
 VALIDITY AND RELIABILITY

• Prior to data collection, the questionnaire will be pretested on ten

midwives from the ANC, labor ward, lying -In and NICU of
Kwahu Government Hospital, Kwahu Atibie. The respondents
will be educated on how to provide answers to the questionnaire
appropriately.
 LIMITATIONS
1. The study will make use of only quantitative research method,
as such; the actual resuscitation skills of respondents would not be
assessed.

2. Since convenient sampling method would be used, the study

sample will not be a representative of all the midwives in the study
area.
 REFERENCES

• Agrawal, N., Kumar, S., Balasubramaniam, S. M., Bhargava, S., Sinha, P., Bakshi, B., &

Sood, B. (2016). Effectiveness of virtual classroom training in improving the

knowledge and key maternal neonatal health skills of general nurse midwifery

students in Bihar, India: A pre- and post-intervention study. Nurse Education Today,

36, 293-297. doi: http://dx.doi.org/10.1016/j.nedt.2015.07.022

• Bull, A., & Sweet, L. (2015). Midwifery students receiving the newborn at birth: A pilot

study of the impact of structured training in neonatal resuscitation. Nurse Education

in Practice, 15(5), 387-392. doi: http://dx.doi.org/10.1016/j.nepr.2015.03.002

 REFERENCES
• Carolan-Olah, M., Kruger, G., Brown, V., Lawton, F., & Mazzarino, M. (2016).

Development and evaluation of a simulation exercise to prepare midwifery students

for neonatal resuscitation. Nurse Education Today, 36, 375-380. doi:

http://dx.doi.org/10.1016/j.nedt.2015.09.009

• Deorari, A. K., Paul, V. K., Singh, M., & Vidyasagar, D. (2010). Impact of education and

training on neonatal resuscitation practices in 14 teaching hospitals in India. Annals of

Tropical Paediatrics, 21(1), 29-33. doi: 10.1080/02724930123814

• Edmond, KM, Quigley, MA, Zandoh, C, et al., (2008). Aetiology of stillbirths and
neonatal
deaths in rural Ghana: implications for health programming in developing countries.
 REFERENCES
• Pediatric and Perinatal Epidemiology, 22(5):430-437.
FMOH, Integrated maternal, new born and child health
strategies. Abuja, Nigeria. 2017.