BackgroundNewborn deaths comprise nearly half of under-5 deaths in Ghana, despite the fact that skilled birth attendants (SBAs) are present at 68% of births, which implies that evidence-based care during labor, birth and the immediate postnatal period may be deficient. We assessed the effect of a low-dose, high-frequency (LDHF) training approach on long-term evidence-based skill retention among SBAs and impact on adverse birth outcomes.MethodsFrom 2014 to 2017, we conducted a cluster-randomized trial in 40 hospitals in Ghana. Eligible hospitals were stratified by region and randomly assigned to one of four implementation waves. We assessed the relative risks (RRs) of institutional intrapartum stillbirths and 24-h newborn mortality in months 1–6 and 7–12 of implementation as compared to the historical control period, and in post-intervention facilities compared to pre-intervention facilities during the same period. All SBAs providing labor and delivery care were invited to enroll; their knowledge and skills were assessed pre- and post-training, and 1 year later.ResultsAdjusting for region and health facility type, the RR of 24-h newborn mortality in the 40 enrolled hospitals was 0·41 (95% CI 0·32–0·51; p < 0.001) in months 1–6 and 0·30 (95% CI 0·21–0·43; p < 0·001) in months 7–12 compared to baseline. The adjusted RR of intrapartum stillbirth was 0·64 (95% CI 0·53–0·77; p < 0·001) in months 1–6 and 0·48 (95% CI 0·36–0·63; p < 0·001) in months 7–12 compared to baseline. Four hundred three SBAs consented and enrolled. After 1 year, 200 SBAs assessed had 28% (95% CI 25–32; p < 0·001) and 31% (95% CI 27–36; p < 0·001) higher scores than baseline on low-dose 1 and 2 content skills, respectively.ConclusionsThis training approach results in a sustained decrease in facility-based newborn mortality and intrapartum stillbirths, and retained knowledge and skills among SBAs after a year. We recommend use of this approach for future maternal and newborn health in-service training and programs.Trial registrationRetrospectively registered on 25 September 2017 at Clinical Trials, identifier NCT03290924.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1705-5) contains supplementary material, which is available to authorized users.

Background and Objective: Koose as an economical Ghanaian local dish prepared from cowpea can be eaten with moringa leaves or velvet tamarind leaves as a meal in the Northern part of Ghana. As part of strategies to promote the consumption of Ghanaian local dishes, the study sought to review the form of preparing and presenting the meal, introduce a different approach to the preparation and presentation of the meal as well as preparing the meal with dandelion leaves and testing its acceptability within the Wa Township. Materials and Methods:The study employed a descriptive survey design with a sample size of 156 consumers as panellists for sensory evaluation of three samples of the food. The sensory characteristics of the three samples of "koose" and leaves were judged by panellists using the hedonic scale of five-point on the sensory attributes of appearance, overall taste, moisture, texture, aroma, preparation and acceptability amongst other things. Results: Using the Kruskal-Wallis Test, significant differences were seen in appearance across the 3 categories of food samples. The findings revealed that the appearance of "koose with leaves" presented as koose salad was preferred over the usual koose mashed with leaves presented. The sample prepared with dandelion leaves were perceived to be more moist and tender than the samples prepared from moringa leaves. The preparation of samples 2 and 3 was perceived to be more hygienic than sample 1. The study revealed that koose salad was more accepted. Conclusion: Local dishes will have to be presented neatly and attractively to boost patronage as consumers will find more attractively served dishes more acceptable.