KNOWLEDGE OF HEALTHCARE PROVIDERS AND FACILITY READINESS ASPHYXIA IN HEALTH FACILITIES IN OSUN STATE, NIGERIA

Title: Knowledge of Healthcare Providers and Facility Readiness for the Management of Perinatal Asphyxia in Selected Healthcare Facilities in Osun State, Nigeria. Abstract This study estimated the prevalence of perinatal asphyxia (PA) and assessed the knowledge of newborn resuscitation (PA management) among healthcare providers (HCPs). It also assessed the facility readiness for the management of PA and explored the barriers to its management in selected healthcarefacilities in Osun State. The purpose of this study was to provide information on the resources available for managing perinatal asphyxia. This study employed the use of an explanatory sequential mixed-method design. We selected one hundred and fifty-six (156) healthcare providers from twenty healthcare facilities (HCFs) in Osun State using a multistage sampling technique. The study was conducted in labour and newborn care units of the selected HCFs, and all the records of newborns (inborn and out-born) from January to December 2019 were retrieved, and those with asphyxia were included in the study. We estimated the prevalence of PA using a self-developed checklist. Knowledge of HCPs on the management of PA was assessed using a 92-item questionnaire, while facility readiness was assessed using a 50-item facility inventory checklist. We adapted both from the Service Availability and Readiness Assessment and the Service Provision Assessment survey tools. We used an interview guide and a 26-item Likert scale questionnaire to explore barriers. Data were analysed in SPSS version 23 using frequency, percentages, pie charts, bar charts, chi-square, correlation, and ANOVA at P<0.05. We analysed the interview responses using content and thematic analysis. The estimated prevalence of PA was 12.7%, with the highest rate at the tertiary health facility levels. Regarding the knowledge of PA management, 90.8% of nurses, 76.5% of medical officers, and 33.3% of community health extension officers had adequate knowledge, respectively. On the whole, 75% of the HCPs had adequate knowledge of the management of PA, and the level of knowledge was significantly associated with job category (p = 0.001) and facility level (p = 0.001). Overall, the average readiness scores were 20.5%, 42.7%, and 61.1% for primary, secondary, and tertiary HCFs, respectively. However, based on the standard indicator for facility readiness (100%), according to the World Health Organisation, the results show that none of the HCFs were ready to manage PA. The qualitative analysis revealed four major themes regarding the barriers to managing PA. The identified barriers include those related to healthcare providers, parents, facilities, and government factors. Burnout and boredom, as well as a reduction in providers' motivation, confidence, skill retention, and facilities' readiness to manage PA, were associated with these barriers. This study concluded that perinatal asphyxia is still prevalent across all levels of healthcare facilities, and knowledge of management varies across the different categories of healthcare practitioners. The readiness of healthcare facilities to manage perinatal asphyxia was found to be suboptimal. Key words: perinatal asphyxia, facility readiness, knowledge, healthcare providers, neonatal resuscitation