Introduction

Prematurity, defined by the World Health Organisation (WHO) as birth before 37 completed weeks of gestation, is a major public health challenge globally. In 2020, approximately 13.4 million babies were born prematurely, accounting for 10% of all live births [1]. Prematurity remains the leading cause of neonatal death and long-term health issues, including respiratory, neurological, and developmental disorders [2].

The burden of prematurity is disproportionately high in low- and middle-income countries, especially in sub- Saharan Africa and South Asia, which together account for 65% of global preterm births [3]. In Chad, neonatal mortality remains among the highest worldwide—approximately 32 deaths per 1,000 live births—driven by limited access to specialised neonatal care, inadequate equipment, and insufficiently trained personnel [4].

To address these disparities, FIGO launched the PremPrep-5 initiative in 2024 [5]. This model encompasses five vital, evidence-based interventions for managing preterm labour and neonatal care.

1. Antenatal corticosteroid administration for lung maturation in preterm foetuses [6].
2. Magnesium sulphate therapy for neuroprotection in foetuses under 32 weeks [7].
3. Delayed cord clamping for improved haematological status [8].
4. Early initiation of breastfeeding within the first hour after birth [9].
5. Immediate kangaroo mother care (KMC) for thermal regulation and bonding [10].

Despite their proven efficacy and low cost, these interventions are applied inconsistently in many low-resource hospitals. This study aimed to evaluate the feasibility and impact of implementing PremPrep-5 interventions at the MCAH of N’Djamena.

Methods

Study design and setting

A descriptive, analytical cross-sectional study was carried out from March to May 2025 at the Mother and Child Academic Hospital of N’Djamena, the nation’s main referral centre for neonatal care.

Population and sampling

The study targeted:

• Healthcare professionals working in maternity and neonatal units (n = 31).
• Preterm newborns (gestational age < 37 weeks) admitted during the study period (n = 64).

A non-probabilistic recruitment approach was employed due to the limited number of eligible cases and staff.

Discussion

This study shows that integrating PremPrep-5 interventions into clinical practice is both feasible and effective in resource-limited neonatal settings. Despite high awareness of specific components, actual implementation remains inconsistent—particularly for magnesium sulphate therapy and delayed cord clamping.

The studied group mainly consists of young paediatricians and obstetricians. Continuing education is vital for these less experienced staff members to perform neonatal procedures competently, as emphasised by Bhuta et al. (2014) [11].

Prenatal corticosteroids, KMC, and early breastfeeding are universally recognised, but magnesium sulphate neuroprotection remains underused despite its proven benefits in reducing the risk of cerebral palsy in premature infants [12].

These findings reflect those reported in Benin and Burkina Faso, where limited training and a lack of standardisation were major barriers to effective neonatal care [13]. The observed link between antenatal corticosteroids and reduced respiratory distress syndrome aligns with Cochrane evidence [14]. Meanwhile, early initiation of breastfeeding has been shown to significantly improve neonatal survival, consistent with UNICEF’s 2018 findings [15].

The inconsistent results for KMC may be due to inadequate adherence to the protocol or inconsistent implementation, rather than a lack of effectiveness. Evidence from WHO (2023) strongly supports continuous skin-to-skin contact as a vital, life-saving measure [16].

Respiratory distress syndrome and infections continue to be the most common complications, aligning with trends observed in sub-Saharan Africa [17-20]. However, the neonatal mortality rate is notably higher than the regional average, reflecting a particularly high-risk hospital environment worsened by poor hygiene, limited resources, and inadequate training.

Study limitations

This study’s limitations include a relatively small sample size, potential reporting bias in self-reported practices, and incomplete medical records. However, it provides essential baseline data for enhancing neonatal care practices in Chad.

Conclusion

The PremPrep-5 initiative provides a practical and cost-effective approach to enhancing neonatal outcomes in low-resource settings. Implementation at MCAH demonstrated clear benefits, particularly in reducing respiratory distress syndrome and improving survival rates among preterm infants. Ensuring sustainable impact requires ongoing professional training, standardised national protocols, and sufficient resource allocation. Commitment at the institutional and policy levels to the PremPrep-5 framework could significantly decrease neonatal mortality in Chad.

Declarations

Ethics approval and consent to participate: Approved by the Ethics Committee for Health Research at the Faculty of Health Sciences. Written consent obtained. Competing interests: None declared.

Funding: No external funding was received.

Acknowledgements: The authors thank the staff of MCAH N’Djamena for their participation and collaboration.

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