Healthcare professionals’ experiences and perspectives of neonatal near misses at three public hospitals in The Gambia: a qualitative study

Background/Aims A neonatal near miss refers to cases where babies almost die in the neonatal period. Exploring healthcare professionals’ experiences and perspectives is vital to understand the dynamics behind neonatal near misses, how to prevent them and how care can be improved. This study's aim was to explore healthcare professionals’ experiences and perceptions of caring for neonatal near misses in major public hospitals in the Western 1 region of The Gambia. Methods Semi-structured interviews were held with purposively selected healthcare professionals, including 9 midwives, 9 nurses and 9 doctors, who worked at three tertiary hospitals in the Western 1 region. Qualitative content analysis was used to generate themes and subthemes focused on the participants’ experiences of providing care in cases of a neonatal near miss. Results The main theme was ‘it could be different’, which included two subthemes: ‘always a near miss baby at the ward’ and ‘ready to care’. The participants described how insufficient human and material resources and poor work environments resulted in neonatal near misses, as well as their inability to intervene in the case of many neonatal deaths. Conclusions This study identified critical gaps in neonatal care, including inadequate investment in healthcare infrastructure, limited availability of life-saving equipment and insufficient neonatal training programmes. High clinical workload, staff shortages and increasing demand for neonatal services contribute to delays in care, which increase the risk of neonatal near-miss events and mortality. Implications for practice Effective management of neonatal near-miss cases in low-resource settings requires strengthened neonatal training, adequate staffing and reliable access to essential equipment. Preventive strategies, including improved antenatal care, efficient clinical workflows and timely referral systems, are essential to improving neonatal outcomes.