Fidelity of Health Care Providers on Adhering to Guidelines for Managing Neonates With Respiratory Distress Using Silverman Anderson Severity (Sas) Score Tool in Limited Resource Settings: A Case Study at Amana Regional Referral Hospital

Abstract Background: This case study was conducted at Amana Regional Referral Hospital, a referral hospital of Ilala District in Dar es Salaam Region Tanzania. The aim is to assess the adherence of healthcare providers to guidelines when providing health services to neonates with respiratory distress and how supportive the health system is in limited resource settings. Methods: It was a case study that used a qualitative approach to data collection and analysis. A total of 16 participants did participate in this study of which the sample size was reached by the principle of information saturation. The study population was healthcare providers (pediatricians, general medical doctors, and nurses) working in the neonatal ward who were selected purposively depending on their experience in the neonatal ward. In-depth interviews (IDI) and an observation checklist were used for data collection from key informants and content analysis was used to analyze the data. Results: The findings revealed that healthcare providers did not fully adhere to the guidelines when managing neonates with respiratory distress. The Silverman-Anderson Severity (SAS) score tool is of use to asses the neonate’s respiratory distress status. It is used for decision-making in prioritizing neonates to Continuous Positive Airway Pressure (CPAP) and monitoring them. They did know the use of the SAS score tool, which was even posted in the ward they are working in for them to follow but yet they showed partial adherence to use it. While healthcare providers displayed partial adherence, various challenges within the health system negatively impacted their consistent adherence. Factors such as understaffing, inadequate training, a shortage of CPAP machines, heavy workloads, and lack of motivation emerged as significant deterrents to adherence. These challenges hindered proper monitoring, documentation, and decision-making processes for CPAP initiation and monitoring. Conclusion: The conclusion of the study highlights that healthcare providers at Amana Regional Referral Hospital demonstrated partial adherence to guidelines for managing neonates with respiratory distress, particularly in the consistent use of the Silverman Anderson Severity (SAS) score tool. Despite awareness of the tool and its importance, challenges such as understaffing, inadequate training, and a shortage of CPAP machines hindered full adherence. Addressing these challenges, including improving staffing, offering comprehensive training, and ensuring equipment availability, is crucial for enhancing adherence and improving neonatal care in resource-limited settings.