Contextual factors influencing bubble continuous positive airway pressure implementation for paediatric respiratory distress in low-income and middle-income countries: a realist review.

Autor:	Ijaz N; Yale School of Medicine, New Haven, CT, USA; Yale National Clinician Scholars Program, New Haven, CT, USA. Electronic address: nadir.ijaz@yale.edu., Nader M; Yale School of Medicine, New Haven, CT, USA., Ponticiello M; Yale School of Medicine, New Haven, CT, USA., Vance AJ; Henry Ford Health, Detroit, MI, USA., van de Water BJ; Boston College, Chestnut Hill, PA, USA., Funaro MC; Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA., Abbas Q; Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan., Adabie Appiah J; Paediatric Intensive Care Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana., Chisti MJ; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh., Commerell W; Technische Hochschule Ulm (THU), Ulm, Germany., Elvis Dzelamunyuy S; Nkwen District Hospital, Bamenda, Cameroon., Martinez Fernandez R; KK Women's and Children's Hospital, Singapore., Gonzalez AL; Department of Biomedical Engineering, Yale University, New Haven, CT, USA., Johnston C; Postgraduate Program in Pediatrics, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil., Luckson Kaiwe E; Mercy James Centre for Paediatric Surgery and Intensive Care Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi; Kamuzu University of Health Sciences, Blantyre, Malawi., Kaur M; Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India., Lang HJ; Heidelberg Institute for Global Health, Heidelberg, Germany; Alliance for International Medical Action, Dakar, Senegal., McCollum ED; Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Marcos González Moraga J; Hospital Regional del Libertador Bernardo O'Higgins, Rancagua, Chile., Muralidharan J; Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India., Renning K; Seed Global Health, Blantyre, Malawi., Tan HL; KK Women's and Children's Hospital, Singapore., Alejandra Vélez Ruiz Gaitán L; WHO, Geneva, Switzerland., González-Dambrauskas S; Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay; Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay., Wilson PT; Section of Pediatric Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA., Morrow BM; Department of Paediatrics, University of Cape Town, Cape Town, South Africa., Davis JL; Yale School of Medicine, New Haven, CT, USA; Yale School of Public Health, New Haven, CT, USA.
Jazyk:	angličtina
Zdroj:	The Lancet. Global health [Lancet Glob Health] 2024 Dec 12. Date of Electronic Publication: 2024 Dec 12.
DOI:	10.1016/S2214-109X(24)00453-4
Abstrakt:	Background: Bubble continuous positive airway pressure (bCPAP) is a low-cost, non-invasive respiratory support therapy for children with respiratory distress, but its effectiveness is dependent on the context. We aimed to understand contextual factors influencing bCPAP implementation for children aged 1-59 months in low-income and middle-income countries (LMICs) and to develop a theory explaining how these factors influence implementation outcomes. Methods: In this realist review, we generated an initial programme theory comprising candidate context-mechanism-outcome configurations (CMOCs) via review of key references and team discussion. On July 25, 2023, we conducted a search for peer-reviewed and grey literature, without date restrictions, describing bCPAP use for paediatric respiratory distress in LMICs. We included references describing related contexts, mechanisms, or outcomes. We coded statements from the literature supporting each CMOC, iteratively revising and adding CMOCs using inductive and deductive logic. We assembled an international, interdisciplinary panel of 22 bCPAP stakeholders to refine CMOCs using iterative surveys, focus groups, and interviews until we reached thematic saturation. This realist review is registered with PROSPERO (CRD42023403584). Findings: Of 1640 peer-reviewed references and eight grey literature references retrieved, 38 peer-reviewed articles and two grey literature documents were deemed eligible for inclusion after removal of duplicates and screening. After four rounds of expert surveys and three focus groups, we identified 18 CMOCs. CMOCs were synthesised into a final programme theory operating at five levels to influence implementation feasibility, fidelity, and sustainability: (1) the bCPAP device, (2) local partnerships and infrastructure, (3) clinical and technical teams, (4) caregivers and the community, and (5) institutional practices. Interpretation: Using realist methods with a diverse, international stakeholder panel, we generated a theory that could explain how bCPAP therapy works in different contexts. This theory could be leveraged to enhance the rigour of future bCPAP implementation trials. Funding: Yale National Clinician Scholars Program, US National Center for Advancing Translational Science (TL1TR001864), and National Heart, Lung, and Blood Institute (T32HL155000). Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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