Newborn Care Training Research Articles

The effect of emergency obstetric and newborn care training interventions on knowledge and skills of midwifery students prior to graduation in Kenya: A quasi-experimental study using a non-randomised controlled study design

IntroductionImproving access to emergency obstetric and newborn care (EmONC) improves maternal and newborn health. However, there is evidence that the pre-service midwifery training curriculum is deficient in developing countries. PurposeThis study measured the effectiveness of pre-service Emergency obstetric care training intervention package on the knowledge and skills of final year midwifery students in Kenya. MethodsThe study was a quasi-experimental controlled trial (ISRCTN 74563398) with one control and two intervention arms (full and partial), involving 12 Kenya Medical Training Colleges (KMTCs) and 381 final year midwifery students. Intervention arms’ KMTCs received EmONC skills training equipment, training of lecturers on teaching methods, EmONC and clinical supervision skills, (and 12 months of mentoring for full intervention arm). Control arm KMTCs had no intervention. Students’ knowledge and practical skills scores 12 months after the bundle of interventions were analysed using mixed effects linear models. ResultsA statistically significant difference was detected between the study arms for the practical skills test (p < 0.001) but not for the knowledge test (p = 0.23). The odds of achieving scores of 80 % or higher in the knowledge test was significantly higher in the full intervention group A compared to the control group OR 3.2 (1.1 – 9.8), p < 0.05. The scores in the skills tests were significantly higher in the intervention groups A and B compared to the control group 14.5 (4.2 – 24.9), p < 0.001 and 24.9 (14.5–35.2) respectively. ConclusionThe pre-service EmONC intervention package was effective in improving the knowledge and skills of final year midwifery students.

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

ObjectivesImmediate postnatal care is a critical intervention to reduce maternal and neonatal morbidity and mortality; however, many women and newborns receive inadequate postnatal care timely and effectively during the first...

Evaluation of the Emergency Obstetric and Newborn Care training in Gondar, Ethiopia; a mixed methods study.

In Ethiopia maternal and perinatal morbidity and mortality remains high. Timely access to quality emergency obstetric and neonatal care is essential for the prevention of adverse outcomes. Training healthcare providers can play an important role in improving quality of care, thereby reducing maternal and perinatal mortality and morbidity. The aim of this study was to evaluate change of knowledge, skills and behaviour in health workers who attended a postgraduate Emergency Obstetric and Newborn Care training in Gondar, Ethiopia. A descriptive study with before-after approach, using a mix of quantitative and qualitative data, based on Kirkpatrick's model for training evaluation was conducted. The evaluation focussed on reaction, knowledge, skills, and change in behaviour in clinical practice of health care providers and facilitator's perspectives on performance. A 'lessons learned approach' was included to summarize facilitators' perspectives. Health care providers reacted positively to the Emergency Obstetric and Newborn Care training with significant improvement in knowledge and skills. Of the 56 participants who attended the training, 44 (79%) were midwives. The main evaluation score for lectures was 4,51 (SD 0,19) and for breakout sessions was 4,52 (SD 0.18) on scale of 1-5. There was a statistically significant difference in the pre and post knowledge (n = 28, mean difference 13.8%, SD 13.5, t = 6.216, p<0.001) and skills assessments (n = 23, mean difference 27.4%, SD 22.1%, t = 5.941, p<0.001). The results were the same for every component of the skills and knowledge assessment. Overall, they felt more confident in performing skills after being trained. Local sustainability, participant commitment and local context were identified as challenging factors after introducing a new training program. In Gondar Ethiopia, the Emergency Obstetric and Newborn Care training has the potential to increase skilled attendance at birth and improve quality of care, both vital to the reduction of maternal and perinatal mortality and morbidity.

Evaluation of Effectiveness Emergency Obstetric and Newborn Care (EONC) Training Program on Pre Hospital Emergency Health Care Personel : Pre-Test and Post-Test Study

Amaç: Bu çalışmada Acil Obstetrik ve Yenidoğan Bakımı (AOYB) konularında hastane dışı acil sağlık profesyonellerinin bilgi düzeylerinin ölçülmesi ve verilen eğitimin teorik bilgiye katkısını değerlendirmek amaçlanmıştır.&#x0D; Gereç: 92 hastane dışı acil sağlık profesyonelinin yaş, cinsiyet, mesleki deneyimleri, hastane öncesi ortamda doğum veya obstetrik komplikasyonlarla karşılaşma sıklığı ve obstetrik aciller ile ilgili çoktan seçmeli sorulardan oluşan ön test uygulanmıştır. Üç gün süren teorik ve pratik eğitimin ardından aynı sorular son test olarak tekrar uygulanmıştır. Ön test ve son test puanları arasındaki farkları analiz etmek için Wilcoxon işaretli sıra testi kullanıldı. p &lt; 0.05 değerleri istatistiksel olarak anlamlı kabul edildi.&#x0D; Bulgular: Katılımcıların %52.2 (n=48)’i kadın, %47.8 (n=44)’ü erkek idi. Yaş ortalaması 35,97 ± 6,62 idi. Paramedikler % 52 (n=48) kişi ile popülasyonun en kalabalık grubunu oluşturdu. Katılımcıların meslekteki çalışma deneyimleri ortalama 14,8 ± 6,22 yıl idi. Hastane dışı ortamda doğum veya obstetrik komplikasyonlarla karşılaşma sıklığı katılımcılar arasında %52.2’idi. Katılımcıların % 79.3 (n =73)’ü kendini obsterik aciller ve doğum konusunda yetersiz hissetmekte olup %65.2 ( n=60)’ı bu konuda lisansüstü eğitim almamıştı. Kadın katılımcılar pre-testte istatistiksel olarak anlamlı düzeyde erkeklerden daha başarılı iken (p= .878), post-testte sorulara doğru cevap verme oranında cinsiyetler arasında farklılık saptanmadı (p=1.00). AOYB bilgi sorularına genel test puanlarının karşılaştırıldığında ise eğitim sonunda katılımcılar istatistiksel olarak anlamlı düzeyde daha başarılı olduğu saptandı (p&lt; 0,001).&#x0D; Sonuç: AOYB eğitim programı ile ölçülebilir bir gelişme saptandı (p &lt; 0,001). Maternal ve neonatal morbidite ve mortaliteyi azaltmak için eğitim kursları, kanıta dayalı bakım ihtiyacı konusunda artan farkındalık ve ekip çalışmasını teşviki, AOYB konusundaki bilgi düzeylerinin güncellenmesi önerilir.

Evaluation of existing Home Based Newborn Care (HBNC) services and training for improving performance of Accredited Social Health Activists (ASHA) in rural India: A multiple observation study

BackgroundOne-fourth of global neonatal deaths occur in India alone. Accredited Social Health Activists (ASHA) was launched with the purpose of improving healthcare services, including neonatal survival primarily in rural areas. The aim of this study is to determine the status of ASHA's knowledge, practices, and attitude regarding Home Based Newborn Care (HBNC) services, as well as to provide necessary trainings for improvement of their performance. MethodsFor this study, 102 ASHA working in Doiwala were recruited at random, and Quasi Experimental Design - Multiple Observation Method (single group time series design) was adopted. The data were collected using pretested tools consisting of knowledge questionnaires, attitude scale, and practices and skill-based questionnaires on various domains of HBNC. The data from the ASHA were collected 4 times at a regular interval of 30 days. Each time, the assessment of ASHA was accompanied by re-education and training on HBNC. ResultsEven though, about 90% of ASHA had been working for more than 5 years, they possessed average knowledge regarding HBNC before the training. Less than 50% of them were aware of mandatory vaccines and infection care services for newborns. About 70% of them were uninformed about the potential risk of hypothermia in neonates and also lacked knowledge regarding its preventive measures. Their knowledge, practices and attitude regarding HBNC was significantly improved after the training (p ˂ 0.05). About 54% of ASHA became aware of the avoidance of pre-lacteal feeding in newborns. Their practices score regarding prevention of hypothermia was increased from 80% to 95%. The number of ASHA who understood the importance of Kangaroo Mother Care (KMC) was also increased from 56% to 87%. About 95% of the ASHA understood the significance of feeding breast milk to newborns. Moreover, the attitude of ASHA towards the traditional way of newborn care such as early bathing, giving pre-lacteal feed, application of turmeric and ghee to the umbilicus of baby etc. was significant improved. ConclusionASHA must be assessed regularly in order to identify their basic needs, knowledge gaps, challenges and difficulties to quality HBNC services. Proper training on HBNC at regular interval significantly improved their knowledge, practices, and attitude toward their responsibilities, which is crucial for improving newborn health status.

The determinants of staff retention after Emergency Obstetrics and Newborn Care training in Kenya: a cross-sectional study

IntroductionKenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmONC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmONC training in Kenya.MethodsA cross-sectional review of EmONC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January–February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed.ResultsA total of 927 SHP were trained from 2014–2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p < 0.05). Interval from training in years (1 year, AOR = 4.2 (2.1–8.4); cadre (nurse/midwives, AOR = 2.5 (1.4–4.5); and county (Uasin Gishu AOR = 9.5 (4.6- 19.5), Kilifi AOR = 4.0 (2.1–7.7) and Taita Taveta AOR = 1.9 (1.1–3.5), p < 0.05, were significant determinants of staff retention in the maternity departments.ConclusionRetention of EmONC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmONC training.

Neonatal stabilization in Canada: Updates to acute care of at-risk newborns (ACoRN) practices and programming.

Disparities in preterm birth and neonatal mortality rates persist in Canada, in part as the result of insufficient training in newborn resuscitation and stabilization care, and inconsistent adherence to best practices. The Neonatal Resuscitation Program (NRP) has been the standard of care in all facilities providing perinatal care in Canada since the 1990s, but perinatal care providers and educators have continued to recognize gaps in knowledge and skill when stabilizing newborns post-resuscitation, especially in settings where this care is encountered infrequently. The Acute Care of at-Risk Newborns (ACoRN) program was developed to bridge such gaps. In ACoRN, an initial Primary Survey and systems-based care pathways (Sequences) prioritize and guide the assessment, essential care, and management of at-risk or unwell newborns in the first hours and days of life. This practice point highlights changes to practice and recommendations since 2012, when the ACoRN text and program were last revised. Like NRP, ACoRN is administered in Canada by the Canadian Paediatric Society (CPS). A newly revised and updated textbook and teaching program, both launched in 2021, will standardize care, increase competence and confidence among perinatal care providers, and improve neonatal outcomes in Canada and elsewhere in years to come.

Effect of a perinatal care quality improvement package on patient satisfaction: a secondary outcome analysis of a cluster-randomised controlled trial

ObjectiveTo investigate the effect of a quality improvement (QI) package on patient satisfaction of perinatal care.DesignSecondary analysis of a stepped-wedge cluster-randomised controlled trial. Participating hospitals were randomised by size into...

Nurses’ and midwives’ knowledge and practice of recommended evidence-based preterm care interventions in rural Kenya

BackgroundApproximately 25% of four million neonatal deaths globally are due to preterm birth, a majority occurring within the first week of life and, 60% in sub-Saharan Africa. Clinical interventions to improve preterm babies’ outcomes are often not used. The study assessed the availability of preterm care guidelines and resources in rural public health facilities in Kenya and nurses/midwives’ knowledge and practice of preterm care interventions as per the current preterm policies and guidelines in Kenya. MethodsA hospital-based cross-sectional design was conducted in 16 health facilities and among 102 nurses and midwives. Data were collected between January and March 2018 using the health assessment checklist and vignettes-based questionnaire. Frequencies and percentages were used to describe participants’ characteristics, availability of guidelines, equipment and medicines, and knowledge, and practice on preterm care interventions. All analyses were performed using Stata 13. ResultsSixteen public health facilities and 102 nurses were assessed. The mean age and period of clinical practice were 36 (SD: 9) and 12 (SD: 10) years, respectively. 71 (70%) participants were females, and 78 (77%) registered nurses. Three-quarters (n = 76, 74.5%) of them had in-service training in newborn care within the last two years, majority 67% (n = 69) worked at health centres/dispensaries. Vitamin K and chlorhexidine were available only in 60.8% and 47.1% of the facilities respectively. Guideline’s availability in facilities were 53%, 43%, and 32% for resuscitation, warmth provision, and breastfeeding within one hour respectively. None of the nurses would practice all the recommended preterm care intervention with 17 (16.7%) practicing none. The practice of the recommended preterm care intervention ranged from 7.6% for initiation of breathing to 29% for cord clamping, 32.4% use of chlorhexidine for cord care, 36.3% immediate feeding and 47.1% thermal protection. ConclusionThere exist gaps in the availability of medicines, equipment and guidelines for care of preterm babies, as well as implementation of evidence-based interventions to enhance the quality of care provided to preterm babies in the study area. We recommend increased provider-focussed strategies for improving the availability and implementation of low-cost high-impact evidence-based interventions for preterm care.

Essential newborn care practice and associated factors among obstetric care providers of public hospitals in Sidama regional state, Ethiopia.

Introduction:The global neonatal death rate was predicted to be 18 per 1000 live births during the first 28 days of life. Ethiopia continues to have one of the highest neonatal mortality rates in the world. Essentially, over 70% of these deaths may have been averted or prevented if proper essential newborn care had been provided. The purpose of this study was to assess the practice of essential newborn care and associated factors among obstetric care providers in public hospitals in Sidama regional state, Ethiopia.Methods:This study was conducted from 1 to 30 July 2020, using an institutionally based cross-sectional study design. The study comprised 182 obstetric care professionals from six hospitals chosen at random. EpiData (version 3.1) was used to enter data, which was then exported to SPSS (version 20). Descriptive, bivariable, and multivariable logistic regression were used. Statistical significance of the explanatory variables was declared at p values <0.05.Results:The overall prevalence of good practice on essential newborn care was 56.6% (95% confidence interval = 49.4–63.7). Working in the delivery room (adjusted odds ratio = 3.53, 95% confidence interval = 2.04–10.06), having training in essential newborn care (adjusted odds ratio = 3.65, 95% confidence interval = 1.63–8.17), and access to established essential newborn care protocols (adjusted odds ratio = 6.88, 95% confidence interval = 3.10–15.26) were found to be statistically significant factors of essential newborn care practice.Conclusion:The study found that having necessary newborn care standards, being interested in working in the delivery room, and having essential newborn care training are all important factors in implementing essential newborn care practices. Important knowledge gaps were noted in key areas of essential newborn care.

Training programs to improve identification of sick newborns and care-seeking from a health facility in low- and middle-income countries: a scoping review

BackgroundMost neonatal deaths occur in low- and middle-income countries (LMICs). Limited recommendations are available on the optimal personnel and training required to improve identification of sick newborns and care-seeking from a health facility. We conducted a scoping review to map the key components required to design an effective newborn care training program for community-based health workers (CBHWs) to improve identification of sick newborns and care-seeking from a health facility in LMICs.MethodsWe searched multiple databases from 1990 to March 2020. Employing iterative scoping review methodology, we narrowed our inclusion criteria as we became more familiar with the evidence base. We initially included any manuscripts that captured the concepts of “postnatal care providers,” “neonates” and “LMICs.” We subsequently included articles that investigated the effectiveness of newborn care provision by CBHWs, defined as non-professional paid or volunteer health workers based in communities, and their training programs in improving identification of newborns with serious illness and care-seeking from a health facility in LMICs.ResultsOf 11,647 articles identified, 635 met initial inclusion criteria. Among these initial results, 35 studies met the revised inclusion criteria. Studies represented 11 different types of newborn care providers in 11 countries. The most commonly studied providers were community health workers. Key outcomes to be measured when designing a training program and intervention to increase appropriate assessment of sick newborns at a health facility include high newborn care provider and caregiver knowledge of newborn danger signs, accurate provider and caregiver identification of sick newborns and appropriate care-seeking from a health facility either through caregiver referral compliance or caregivers seeking care themselves. Key components to consider to achieve these outcomes include facilitators: sufficient duration of training, refresher training, supervision and community engagement; barriers: context-specific perceptions of newborn illness and gender roles that may deter care-seeking; and components with unclear benefit: qualifications prior to training and incentives and remuneration.ConclusionEvidence regarding key components and outcomes of newborn care training programs to improve CBHW identification of sick newborns and care-seeking can inform future newborn care training design in LMICs. These training components must be adapted to country-specific contexts.

Effect of education on the readiness levels of primigravida women to hygienic care practices of the newborn with the use of QR code

The researcers planned this study to determine the effect of the education on the hygienic care of the newborn with the use of QR Code on readiness levels of primigravida women to hygienic care practices of the newborn. A total of 68 primigravida women constituted of this interventional study. After the intervention group completed their education on newborn care, mobile application and QR codes were introduced to the pregnant women. The control group received routine newborn care training. It was observed that the education of hygienic care to the newborn, which was provided to pregnant women with the use of QR Code, was effective on their readiness to care. Pediatric nurses can provide QR code supported training to prepare pregnant women for the hygienic care of the newborn.

Partograph utilization as a decision-making tool and associated factors among obstetric care providers in Ethiopia: a systematic review and meta-analysis

BackgroundGlobally, a total of 13.6 million women have died due to maternal causes from 1990 to 2015. Majority of these deaths occurred in resource-limited countries. Among the causes of these deaths, obstructed and prolonged labor covers the highest percentage, which could be prevented by cost-effective and affordable health interventions like partograph use. Therefore, this systematic review and meta-analysis aimed to assess the level of partograph utilization among obstetric care providers and its associated factors in Ethiopia.MethodFor this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed/Medline, Google Scholar, EMBASE, Cochrane Library, HINARI, WHO Afro Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access all the essential articles. Microsoft Excel was used for data entry and Stata version 11.0 (Stata Corporation, College Station, TX, USA) for data analysis.ResultNineteen studies were included in this systematic review and meta-analysis with a total of 6237 obstetric care providers. The overall pooled prevalence of partograph utilization was 59.95% (95% CI 46.8–73.09, I2 = 99.4%, P < 0.001). Being in midwifery profession (adjusted odds ratio (AOR) 3.97; 95% confidence interval (CI) 2.63–5.99, I2 = 28.8%, P = 0.198), presence of supervision (AOR = 3.21; 95% CI 2.22–4.66, I2 = 0.0%, P = 0.742), Basic Emergency Obstetric and Newborn Care (BEmONC) training (AOR = 2.90; 95% CI 2.19–3.84, I2 = 36.9%, P = 0.13), knowledge of partograph (AOR = 2.5; 95% CI 1.6–3.8, I2 = 64.58%, P = 0.024), on-the-job refresher training on partograph (AOR = 5.7; 95% CI 2.5–12.9, I2 = 87.8%, P < 0.001), favorable attitude (AOR = 2.12; 95% CI 1.48–3.04, I2 = 0.0%, P = 0.58), and working at health center (AOR = 3.50; 95% CI 2.49–4.92, I2 = 49.1%, P = 0.08) were the determinant factors for partograph use among obstetric care providers in Ethiopia.ConclusionThe overall pooled prevalence of partograph utilization among obstetric care providers was low. Therefore, supportive supervision, providing Basic Emergency Obstetric and Newborn Care training, on-the-job refresher training on partograph, and promoting midwifery profession are strongly recommended to increase the use of partograph.

Helping Babies Survive and Empowering Midwives and Nurses to Provide Quality Newborn Care.

* Abbreviations: CPD — : continuing professional development HBB — : Helping Babies Breathe ICM — : International Confederation of Midwives MoH — : ministry of health Women and their newborns deserve quality and coordinated care at the time of birth, a vulnerable time when most preventable deaths occur.1 Midwives can provide up to 87% of maternal and newborn care, and when advanced care is needed, they can refer to a medical doctor.2 It is vital for the labor and birth health provider team to work collaboratively, communicate effectively, and maintain competence, especially in the rare cases in which basic emergency obstetric and newborn care is needed. In some countries, traditional basic emergency obstetric and newborn care training has been replaced with shorter and less resource-intensive Helping Babies Survive and Helping Mothers Survive training, developed by the American Academy of Pediatrics and Jhpiego, respectively. The International Confederation of Midwives (ICM), in partnership with national midwives’ associations, has been implementing projects using Helping Babies Survive and Helping Mothers Survive for many years, most recently in the 10 000 (2014–2016) and 50 000 (2018–2020) Happy Birthdays projects, supported by Laerdal Global Health, the American Academy of Pediatrics, Latter-day Saint Charities, and other stakeholders. More than 30 000 midwives from Malawi, Zambia, Ethiopia, Tanzania, and Rwanda were trained, with the ultimate goal of saving maternal and newborn lives … Address correspondence to Florence West, PhD, International Confederation of Midwives, Koninginnegracht 60, 2514 AE The Hague, Netherlands. E-mail: f.west{at}internationalmidwives.org

Prevalence of use of highly concentrated oxytocin or "pepper injection" in labor among clinicians undergoing emergency obstetric training in Sierra Leone.

To examine the awareness, prevalence of use, and knowledge of risks of pepper injection (PI), an injection of highly concentrated oxytocin used to augment or induce labor, among clinicians. An anonymous pre- and post-workshop evaluation conducted among 227 clinicians participating in emergency obstetric and newborn care training in Sierra Leone from June to October 2018. Overall, 225 participants completed the surveys. Of these, 198 (88.0%) of clinicians reported awareness of PI, and 123 (54.7%) self-reported prior use, which was highest among midwives (94/129; 72.9%). Before EmONC training, 82 (36.4%) clinicians reported that they were likely to use PI; this decreased to 39 (17.3%) after training (P<0.05). The mean number of participants correctly identifying risks of PI increased from 149 (66.2%) to 204 (90.7%) after training (P<0.05). There was widespread awareness of PI use among clinicians, and prevalent self-reported prior use among midwives. Risk awareness improved after EmONC training, and the proportion of clinicians reporting likelihood of future use decreased. Improper use of oxytocin may be a major contributor to maternal and newborn morbidity and mortality in Sierra Leone. Initiatives to educate clinicians and to regulate and stop the practice are needed.

Improving the quality of neonatal care in Nigeria through the education of maternity health workers

This study was undertaken to determine the impact of an educational intervention on health care workers' level of satisfaction with the training and the new knowledge gained regarding newborn care. A pre- and post-training knowledge survey, a ‘satisfaction’ survey and group discussions were conducted with 38 health workers at Jos University Teaching Hospital (JUTH), Plateau state, Nigeria.The content included in the training were rated as either ‘very good’ or ‘excellent’ by the majority (94.6%) of the participants. The majority (83.7%) strongly agreed that they would be able to apply most of the material learned to their job. And lastly, the mean post-training score (21.42 ± 1.08) was higher that the pre-training score (17.95 ± 3.08).The newborn care training resulted in a positive experience for the participants and improved their knowledge about newborn care. This study has potentially laid a foundation for positive behaviour change and improved neonatal care and survival in Nigeria.

Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers on day of birth care in Nigeria; a cluster randomized controlled trial

BackgroundThe aim of this study was to compare health workers knowledge and skills competencies between those trained using the onsite simulation-based, low-dose, high frequency training plus mobile mentoring (LDHF/m-mentoring) and the ones trained through traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period.MethodsA prospective cluster randomized controlled trial was conducted by enrolling 299 health workers who provided healthcare to mothers and their babies on the day of birth in 60 health facilities in Kogi and Ebonyi states. These were randomized to either LDHF/m-mentoring (intervention, n = 30 facilities) or traditional group-based training (control, n = 30 facilities) control arm. They received Basic Emergency Obstetrics and Newborn Care (BEmONC) training with simulated practice using anatomic models and role-plays. The control arm was trained offsite while the intervention arm was trained onsite where they worked. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions (MCQs) and objective structured clinical examinations (OSCEs) mean scores were compared; p-value < 0.05 was considered statistically significant. Qualitative data were also collected and content analysis was conducted.ResultsThe mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at end line (p < 0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p < 0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities.ConclusionThe LDHF/m-mentoring intervention is more effective than TRAD approach in improving health workers’ skills acquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery.Trial registrationThe trial was retrospectively registered on August 24, 2017 at ClinicalTrials.Gov: NCT03269240.

Early or delayed umbilical cord clamping? Experiences and perceptions of nurse-midwives and obstetricians at a regional referral hospital in Tanzania.

BackgroundUmbilical cord clamping is a crucial step during the third stage of labour that separates the newborn from the placenta. Despite the available evidence that delayed umbilical cord clamping is more beneficial to infants, as well as the existence of 2014 WHO recommendation that the umbilical cord should be clamped between 1 and 3 minutes, its implementation is still low in many countries including Tanzania.ObjectiveThis study describes the experiences and perceptions of nurse-midwives`and obstetricians`about the timing of umbilical cord clamping at a regional referral hospital in Tanzania.MethodsA descriptive qualitative study design that adopted a purposeful sampling strategy to recruit 19 participants was used. Nine semi-structured interviews with six nurse-midwives`and three obstetricians`, as well as one focus group discussion with ten nurse-midwives`were conducted. Thematic analysis guided the analysis of data.ResultsThree main themes generated from the data, each having 2 to 5 subthemes. 1. Experiences about the timing of umbilical cord clamping. 2. Perceptions about the umbilical cord clamping. 3. Factors influencing the practice of delayed umbilical cord clamping to improve newborn health outcomes.ConclusionAlthough the nurse-midwives`and obstetricians`commonly practiced clamping the umbilical cord immediately after delivery, they understood that delayed cord clamping has a potential benefit of oxygenation to the newborn in the event of the need for resuscitation. To move forward with the good practice in maternal and newborn care, proper pre-service and providers training on matters underlying childbirth is essential to address the gap of knowledge. Delayed cord clamping should be practiced widely to improve the health outcomes of the newborn.

Knowledge and practice of immediate newborn care among midwives and nurses in public health facilities of Afar regional state, Northeast Ethiopia

BackgroundThe care given to newborns immediately within the first few hours of birth is critical for their survival. However, their survival depends on the health professional’s knowledge and skills to deliver appropriate newborn care interventions. Therefore, this study aimed to assess the knowledge and practice of immediate newborn care among nurses and midwives in public health facilities of Afar Regional State, Northeast Ethiopia.MethodsInstitution based cross-sectional study design was employed on 357 nurses and midwives working in 48 public health facilities (45 health centers and 3 hospitals) during April 2018. Data were collected using interviewer-administered questionnaire and observation checklist. Then, data were entered into Epi-info version 7.0 and exported to SPSS version 20 for analysis. Univariable and multivariable logistic regression analyses were carried out to estimate odds ratio with 95% confidence interval. A p-value less than 0.05 was used to declare statistical significance.ResultsOverall, 53.8% [95% CI: (48.6, 59.0%)] and 62.7% [(95% CI: (57.7, 67.8%))] of the health professionals (midwives and nurses) had adequate knowledge and good practice on immediate newborn care, respectively. Working in hospital [AOR: 4.62; 95% CI (1.76, 12.10)], being a female [AOR: 0.59; 95% CI (0.39, 0.98)] and interested in providing newborn care [AOR: 0.29; 95% CI (0.13, 0.68)] were positively associated with having adequate knowledge on immediate newborn care. On the other hand, having work experience of < 5 years [AOR: 0.33; 95% CI (0.14, 0.78)], inadequate knowledge [AOR: 0.39; 95% CI (0.25, 0.64)], having work load [AOR: 2.09; 95% CI (1.17, 3.73)], being not interested to provide immediate newborn care [AOR: 0.35; 95% CI (0.16, 0.74)] and working in health center [AOR: 8.56; 95% CI (2.39, 30.63)] were negatively associated with good immediate newborn care practices.ConclusionsA significant number of nurses and midwives had inadequate knowledge and poor practice on immediate newborn care. Therefore, providing a comprehensive newborn care training and creating an opportunity for nurses and midwives working at health centers to share experience from those hired in hospitals are very crucial to improve their knowledge and skills on newborn care.

Comparing the effectiveness of a blended learning approach with a conventional learning approach for basic emergency obstetric and newborn care training in Ethiopia

BackgroundLack of trained personnel is a major obstacle to providing the full package of emergency obstetric and newborn care (EmONC) services in Ethiopia and other low-income countries. The aim of this study was to evaluate whether a blended learning approach to in-service EmONC training could be as effective as a conventional learning approach while reducing costs. MethodsA quasi-experimental study design assigned providers in need of EmONC training to blended learning (12 days of offsite training followed by daily SMS and weekly phone calls) or conventional learning (18 days of offsite training followed by a facility visit to mentor participants). A self-administered questionnaire measured provider knowledge before training and three months afterwards. Provider skills were assessed three months post-training with an Objective Structured Clinical Examination (OSCE). Independent sample t-test and multiple linear regression analysis were used to assess differences in mean percentage knowledge and skills scores between learning groups. The direct costs and cost-effectiveness of each learning approach were calculated. ResultKnowledge scores were similar for the blended and conventional learning groups before training (58.5% vs 61.5%, p = 0.358) and three months post-training (74.7% vs 75.5% = 0.720), with no significant difference in gains made. Post-training skills scores were significantly higher for conventional than blended learning (85.8% vs 75.3%, p < 0.001). After controlling for other factors in the multiple linear regression analysis, providers with a university degree had significantly higher skills scores than those with a diploma (p < 0.001). Training costs were lower for blended learning than conventional learning (1032 USD vs 1648 USD per trainee). ConclusionBlended learning approach using SMS and phone calls was as effective as conventional one to increase providers’ knowledge with substantially lower costs. Further study is warranted to examine the effect of blended learning on providers’ skills.