The Challenges of Developing Sustainable Neonatal Life Support Programmes in Zambia, A Low to Medium Resourced Country

Background: The Neonatal Intensive Care Unit (NICU) at the Women and Children’s Hospital in University Teaching Hospital Lusaka in Zambia is the country’s only tertiary neonatal unit. The average monthly mortality rate is 25.1%, 23% due to birth asphyxia.

A Neonatal life support (NLS) course based on the UK NLS algorithm was rolled out to local midwives, nursing and medical staff with 356 trained and 12 midwives completing train the trainer courses in 2018. Since then there has been no re training, with concerns skills haven`t been sustained. Infants are brought to NICU without any attempts at resuscitation. This pilot project was developed aiming to deliver shorter sessions directly to staff in clinical areas, minimising disruption of work and improve skills.

Method: Involved medical and nursing staff on NICU, labour ward and in nursing teaching sessions. A pre and post NLS questionnaire was filled out. Sessions included brief introduction to NLS and key differences to paediatric and adult life support. We then taught the NLS algorithm up to the point of drugs being used. Staff had to practically demonstrate skills taught. We did not go over intubation or insertion of UVC as UVCs are not routinely used.

Results: 93% of staff had not received NLS training previously and yet 68% had assisted with real NLS scenarios. Post NLS questionnaires showed improved confidence. 100% of staff felt the session improved their NLS skills, and 100% would be interested in future sessions.

Conclusion: The short small repeated training sessions were well received by the local team and fitted around their clinical work. The team will continue this format and deliver these sessions to as many staff as possible. There will be re-training and re-auditing of staff in a few months time. Further formal training days will be rolled out to staff.