Respiratory support with Continuous Positive Airway Pressure in preterm neonates: an analysis of coverage and quality of care in 66 neonatal units in Kenya, Malawi, Nigeria and Tanzania implementing with the NEST360 Alliance

The study analyzed the provision of continuous positive airway pressure (CPAP) in preterm neonates across 66 neonatal units in four African countries during 2021 to 2024. Of 375,255 total neonatal admissions, 64,761 were eligible for CPAP treatment, but only 22,006 (34 percent) received it. Functional CPAP was available on a median of 16 percent of days, with Tanzania recording a 63 percent increase in coverage over time. Quality of care was suboptimal, as only 10 percent of neonates weighing under 1500 grams started CPAP within the first hour of life. Among neonates with high clinical severity, those who received CPAP had higher survival probability (32 percent) compared to those without treatment (23 percent). Maternal antenatal corticosteroid use was associated with improved neonatal survival odds.