673 - Feasibility and Integration of a Novel Bubble CPAP System in Two Public Referral Hospitals in Accra, Ghana

Publication Number: 3651.673

Shivani M. Ravi, Tufts University, Cambridge, MA, United States; Molly Rudman, University of Michigan Medical School, Ann Arbor, MI, United States; Marie-Charlyne Kilba, Greater Accra Regional Hospital, Accra, Greater Accra, Ghana; Susan Zakariah, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana; Lorraine F. Garg, Vayu Global Health Foundation, Boston, MA, United States; Thomas F. Burke, Harvard Medical School, Medford, MA, United States

Background: In 2023, approximately 2.5 million children aged 1 to 59 months died, with the highest mortality rates observed in Sub-Saharan Africa [1]. A major contributor to mortality in Sub-Saharan Africa is lower respiratory infections. This problem is heightened by the limited availability of respiratory support such as continuous positive airway pressure (CPAP), which is commonly used to treat respiratory distress in high-income countries.

Pediatricians at Greater Accra Regional Hospital and Korle Bu Teaching Hospital in Accra, Ghana expanded the clinical use of a novel bubble CPAP (bCPAP) system, initially designed for neonates, to infants and young children aged 29 days to 36 months. While bCPAP use in low-resource settings for neonates has been well studied, its application in older pediatric populations remains underexplored.

Objective: This qualitative study aims to evaluate the feasibility of use and integration of a novel low-cost bubble CPAP system for patients aged 29 days to 36 months in two public referral hospitals in Ghana.

Design/Methods: Twelve focus group discussions (FGDs) were conducted, six at Korle Bu Teaching Hospital and six at Greater Accra Regional Hospital. Participants included nurses, respiratory therapists, midwives, and doctors who had used the novel bCPAP system in the PICU at Korle Bu Teaching Hospital and in the PICU, pediatric ward, and/or pediatric emergency department at Greater Accra Regional Hospital. All FGDs were audio-recorded, transcribed verbatim, coded, and analyzed to identify emerging themes.

Results: A total of 86 healthcare workers participated in the FGDs, including 47 from Korle Bu Teaching Hospital and 39 from Greater Accra Regional Hospital. Participants reported that the use of the novel bCPAP system reduced PICU referrals from the pediatric ward and emergency department, decreased escalation to mechanical ventilation, and resulted in shorter hospital stays. Healthcare workers described strategies that facilitated device use, such as securing prongs with adhesive tape or bandages, providing peer support for training and troubleshooting, and involving parents in device monitoring. A frequently reported challenge was nasal prong displacement due to inadequate prong sizes for older pediatric patients and patient movement.

Conclusion(s): The novel bCPAP system was successfully integrated in two public referral hospitals in Accra, Ghana to treat older infants and pediatric patients. Further studies are needed to optimize bCPAP use and training across diverse pediatric populations in resource-limited settings.