Abstract
BackgroundNewborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Improving provider newborn resuscitation skills is critical for delivering quality care, but the retention of these skills has been a challenge. Tanzania implemented a national newborn resuscitation using the Helping Babies Breathe (HBB) training program to help address this problem. Our objective was to evaluate the effectiveness of two training approaches to newborn resuscitation skills retention implemented across 16 regions of Tanzania.MethodsAn initial training approach implemented included verbal instructions for participating providers to replicate the training back at their service delivery site to others who were not trained. After a noted drop in skills, the program developed structured on-the-job training guidance and included this in the training. The approaches were implemented sequentially in 8 regions each with nurses/ midwives, other clinicians and medical attendants who had not received HBB training before. Newborn resuscitation skills were assessed immediately after training and 4–6 weeks after training using a validated objective structured clinical examination, and retention, measured through degree of skills drop, was compared between the two training approaches.ResultsEight thousand, three hundred and ninety-one providers were trained and assessed: 3592 underwent the initial training approach and 4799 underwent the modified approach. Immediately post-training, average skills scores were similar between initial and modified training groups: 80.5 and 81.3%, respectively (p-value 0.07). Both groups experienced statistically significant drops in newborn resuscitation skills over time. However, the modified training approach was associated with significantly higher skills scores 4–6 weeks post training: 77.6% among the modified training approach versus 70.7% among the initial training approach (p-value < 0.0001). Medical attendant cadre showed the greatest skills retention.ConclusionsA modified training approach consisting of structured OJT, guidance and tools improved newborn resuscitation skills retention among health care providers. The study results give evidence for including on-site training as part of efforts to improve provider performance and strengthen quality of care.
Highlights
Newborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality
Distribution of trained health care providers Paired data from immediately post-training and 4–6 weeks after training were available from 8391 trainees and were included in the analysis – 3592 undergoing the initial training approach (May 2013–March 2014) and 4799 undergoing the modified approach (May 2014– March 2015) (Table 1)
There was a higher proportion of nurses / midwives in the modified training compared to the initial training and a higher proportion of medical attendants during the initial training approach compared to the modified training approach
Summary
Newborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. To achieve the Sustainable Development Goal of reducing neonatal mortality to 12 per 1000 live births or lower, we must end preventable deaths. Birth asphyxia remains the leading cause of newborn mortality and accounts for nearly 900,000 neonatal deaths annually [3]. Strengthening the capacity of health workers to provide newborn resuscitation is critical to reducing newborn deaths. In response to this challenge, the American Academy of Paediatrics and other partners developed the Helping Babies Breathe (HBB) curriculum [4] to teach providers how to respond to asphyxiated newborns with life-saving measures. The HBB course utilizes simulation like many other life-saving skills courses [5]
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