Abstract
Neonatal mortality in Africa is among the highest in the world. In Liberia, providers face significant challenges due to lack of resources, and providers in referral centers need to be prepared to appropriately provide neonatal resuscitation. A team of American Heart Association health care providers taught a two-day neonatal resuscitation curriculum designed for low-resource settings at a regional hospital in Liberia. The goal of this study was to evaluate if the curriculum improved knowledge and comfort in participation. The curriculum included simulations and was based on the Neonatal Resuscitation Protocol (NRP). Students learned newborn airway management, quality chest compression skills, and resuscitation interventions through lectures and manikin-based simulation sessions. Seventy-five participants were trained. There was a 63% increase in knowledge scores post training (p < 0.00001). Prior cardiopulmonary resuscitation (CPR) training, age, occupation, and pre-intervention test score did not have a significant effect on post-intervention knowledge test scores. The median provider comfort score improved from a 4 to 5 (p < 0.00001). Factors such as age, sex, prior NRP education, occupation, and post-intervention test scores did not have a significant effect on the post-intervention comfort level score. A modified NRP and manikin simulation-based curriculum may be an effective way of teaching health care providers in resource-limited settings. Training of providers in limited-resource settings could potentially help decrease neonatal mortality in Liberia. Modification of protocols is sometimes necessary and an important part of providing context-specific training. The results of this study have no direct relation to decreasing neonatal mortality until proven. A general resuscitation curriculum with modified NRP training may be effective, and further work should focus on the effect of such interventions on neonatal mortality rates in the region.
Highlights
In the last decade, substantial progress has been made in the reduction of under-five child mortality worldwide
As Liberia looks towards achieving the sustainable development goal (SDG) target to reduce neonatal mortality as low as 12 per 1000 live births by 2030, more neonatal resuscitation training program implementation will be necessary [6]
Evaluation of post-intervention scores with regression analysis concluded that pre-intervention test score, prior cardiopulmonary resuscitation (CPR) training, age, and occupation did not have a significant effect
Summary
Substantial progress has been made in the reduction of under-five child mortality worldwide. The global under-five mortality rate was 93 deaths per 1000 live births in 1990. Neonatal mortality rates remain a significant contributor to under-five mortality, increasing from 41% of all under-five deaths in 2000 to 46% in 2017 [1]. Post-war Liberia suffered the devastation of the Ebola epidemic in 2014, resulting in yet another hit to the health care system [3]. Liberia saw a significant decrease in the neonatal mortality rate from 34.2 per 1000 live births in 2006 to 23 per 1000 live births in 2016 [5]. As Liberia looks towards achieving the sustainable development goal (SDG) target to reduce neonatal mortality as low as 12 per 1000 live births by 2030, more neonatal resuscitation training program implementation will be necessary [6]
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