Assessing the health system's capacity to conduct neonatal resuscitation in Ethiopia.
BACKGROUND
Globally and nationally approximately a quarter of neonatal deaths and an unknown number of intrapartum stillbirths are attributed to intrapartum complications known as birth asphyxia. Simple stimulation and resuscitation can save many of these lives.


OBJECTIVE
To describe the capacity of the Ethiopian health system to provide neonatal resuscitation with bag and musk.


METHODS
Cross-sectional data were collected from 741 health facilities and one birth attendant at each facility was interviewed. This paper focuses on 711 nurses and midwives. Based on a guided interview, responses were converted into a knowledge index and we used multivariable linear regression to identify factors that predicted a high score.


RESULTS
Nine out of 10 hospitals, but only 40% of health centers, had performed neonatal resuscitation in the three months prior to the survey. Barriers to performing neonatal resuscitation included missing essential equipment and inadequately trained staff. Half of the midwives interviewed reported having performed neonatal resuscitation in the past three months compared to only 20% of the nurses. After controlling for provider and facility characteristics, key predictors of a high knowledge score among providers were recent performance of neonatal resuscitation and geographic region. Whether the provider was a nurse or a midwife, was not associated with a higher knowledge score.


CONCLUSION
Educators and program managers should insist on practical pre-service and in-service training, ensure the availability of equipment to perform neonatal resuscitation, and prioritize certain regions of the country for these interventions.