Nurses' practices in the management of newborn asphyxia at birth: A cross-sectional study in selected health facilities in Turkana and West Pokot Counties, Kenya

Abstract

Birth asphyxia remains a major contributor to neonatal morbidity and mortality worldwide, accounting for a substantial proportion of newborn deaths, particularly in low-resource settings. Effective management of newborn asphyxia at birth depends largely on the competence of healthcare providers in implementing timely and appropriate neonatal resuscitation interventions. This study assessed nurses' practices in the management of newborn asphyxia at birth in selected health facilities in Turkana and West Pokot counties, Kenya. Guided by Benner's Novice-to-Expert Theory, which posits that clinical competence develops through education, experience, and practice, a descriptive cross-sectional study utilizing a quantitative approach was conducted among nurses working in maternity wards, newborn units, and operating theatres in six purposively selected health facilities in Turkana and West Pokot counties. A census sampling approach was employed to recruit all eligible nurses who had worked in their respective departments for at least one year. Data were collected through direct observation using a modified Helping Babies Breathe (HBB) skills observation checklist adapted from the Care of the Newborn Training Guide. Data were analyzed using SPSS version 28. Descriptive statistics summarized the findings, while inferential statistics examined associations between practice levels and selected variables, with statistical significance set at p ≤ 0.05. A total of 99 nurses were observed. Overall, 85.9% demonstrated good practice in newborn asphyxia management, while 14.1% had poor practice. High levels of adherence were observed in key neonatal resuscitation procedures, including drying and stimulating the newborn (98%), evaluating breathing (99%), recognizing non-breathing newborns (99%), moving infants to a warm surface for ventilation (98%), and clearing airway secretions (99%). However, lower performance was noted in hand hygiene maintenance (74%), equipment preparation (76%), and preparation of the ventilation area (73%). West Pokot County recorded significantly higher good practice levels (92%) than Turkana County (76%) (p=0.025). No statistically significant association was found between practice level and facility ownership (p=0.44). Nurses in the selected facilities generally demonstrated desirable practices in the management of newborn asphyxia at birth, indicating adequate competency in essential neonatal resuscitation procedures. Nevertheless, important gaps remain in infection prevention practices and resuscitation preparedness, particularly in Turkana County. Strengthening competency-based training, mentorship, supportive supervision, and access to essential newborn resuscitation equipment may further improve the quality of newborn care and contribute to reductions in neonatal morbidity and mortality.