{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:38:38Z","timestamp":1785411518891,"version":"3.56.0"},"reference-count":46,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Continuous positive airway pressure (CPAP) therapy is the standard of care for neonatal respiratory distress and improves survival when implemented in low-resource settings. Clinical audits at the Borama Regional Hospital (BRH) Neonatal Intensive Care Unit (NICU) revealed multiple barriers to effective CPAP, including insufficient pressure, a lack of neonatal-sized nasal prongs, and patient interface challenges.\n\nAim:\u00a0Improve respiratory distress by increasing effective CPAP delivery for neonates &lt; 30 days of age from 52% to 90% in 6 months.\n\nSetting:\u00a0Single-centre referral hospital in the Awdal region of Somaliland.\n\nMethods:\u00a0Quality improvement (QI) initiative with outcomes displayed using statistical process control (SPC) charts.\n\nResults:\u00a0Eleven residents, three medical interns and seven NICU nurses completed the educational training. Forty-five patients were initiated on the locally designed bubble CPAP (bCPAP) device with a 47% (122\/261) CPAP safety checklist completion rate for the three daily nursing shifts. We achieved our study aim by increasing the adherence rate to the 7-item bCPAP device set up from a baseline of 52% to 91%. The rate of infants weaned or discontinued from bCPAP for improved respiratory severity score (RSS) increased from 0% to 18% but did not demonstrate process change. There was no increase in adverse event rates (air leak, nasal columella breakdown and nasal irritation).\n\nConclusion:\u00a0We demonstrated increased effective bCPAP delivery and decreased respiratory distress.\n\nContribution:\u00a0This study outlines low-cost, customisable QI strategies to address commonly encountered gaps for effective bCPAP delivery in low-resource settings without access to commercially available CPAP devices or speciality-trained providers.<\/jats:p>","DOI":"10.4102\/phcfm.v17i1.4742","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T04:12:42Z","timestamp":1744949562000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Optimising neonatal bubble continuous positive airway pressure: A Somaliland quality initiative"],"prefix":"10.4102","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5178-4770","authenticated-orcid":false,"given":"Hawa D.","family":"Mahmoud","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034a2ss16","id-type":"ROR","asserted-by":"publisher"}],"name":"Amoud University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5064-3294","authenticated-orcid":false,"given":"Sarah C.","family":"Kent","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034a2ss16","id-type":"ROR","asserted-by":"publisher"}],"name":"Amoud University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0415-3876","authenticated-orcid":false,"given":"Fatima E.","family":"Ibrahim","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034a2ss16","id-type":"ROR","asserted-by":"publisher"}],"name":"Amoud University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0861-7473","authenticated-orcid":false,"given":"Najma","family":"Mohamed","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034a2ss16","id-type":"ROR","asserted-by":"publisher"}],"name":"Amoud University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5045-8351","authenticated-orcid":false,"given":"Fatima A.","family":"Abdulahi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/034a2ss16","id-type":"ROR","asserted-by":"publisher"}],"name":"Amoud University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6040-7695","authenticated-orcid":false,"given":"Meagan N.","family":"O'Neal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017zqws13","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5617-2499","authenticated-orcid":false,"given":"Priya","family":"Kanajam","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017zqws13","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3058-4951","authenticated-orcid":false,"given":"Ellen K.","family":"Diego","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017zqws13","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"key":"ref0","unstructured":"Milton R, Gillespie D, Dyer C, et al. 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