Implementing the Dubowitz assessment of gestational age in India and Malawi: a cross-sectional study of participants in a training workshop

Abstract

BackgroundAccurate assignment of the gestational age of newborns is important for the identification of prematurity. The Dubowitz assessment is the gold standard among postnatal examinations used to assign gestational age, but implementation has been limited because of examination complexity and training requirements. The objective of this study was to explore factors related to teaching and implementing the Dubowitz examination that may influence its uptake in India and Malawi. MethodsThis cross-sectional study was conducted in India and Malawi during the preparation for a low-birthweight infant feeding exploratory study. Twenty trainees participated in a Dubowitz examination training workshop that occurred over two half-day sessions. Trainees completed pretraining and posttraining surveys related to their perceptions of the Dubowitz training, the examination, and factors affecting the administration of the examination in their setting. ResultsAll survey respondents expressed confidence in their ability to perform the Dubowitz examination after the training. Less than a third expressed concerns about the time required to learn (30%) or perform the examination (25%). Eighty-five percent of trainees identified concerns related to parental perception of the examination that may inhibit implementation. Trainees averaged 14 minutes (standard deviation: 4.5 minutes) to complete the examination. More than 80% of trainee answers were within one point of the trainer for 16 of the 22 Dubowitz signs. Trainee composite scores were within ±3 weeks of the trainer for 95% of assessments based on Bland-Altman analysis. ConclusionsThe Dubowitz examination at birth is a method to improve identification of premature infants in the absence of prenatal dating. We found widespread acceptance for the Dubowitz assessment among participants in training workshops in India and Malawi, despite the complexity and length of the examination. The high level of trainee-trainer Co-senior author Co-senior author a b North K, Bellad RM, Bose C, et al. Implementing the Dubowitz assessment of gestational age in India and Malawi: a cross-sectional study of participants in a training workshop.

Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi‐site observational study

“…In this cohort, only 4% had dating based on ultrasound, 65% on last menstrual period and 15% on fundal height. The use of Dubowitz scoring to assess gestational age at the time of birth was acceptable to providers and had high agreement during training between trainers and trainees 11 . However, after implementation of the Dubowitz exam and best obstetric estimate algorithm, only 1.4% of gestational age determination was based on the Dubowitz score.…”

“…The variety of methods complemented each other; the quantitative data provided an overview of infant care, while the direct observation or interviews provided nuance. Further, with the use of traditional academic reporting, abstracts at international conferences and use of webinars and social media to share results in a lay person‐accessible executive summary, we have communicated our findings widely to many key audiences 9–11,17,18 …”

“…Further, with the use of traditional academic reporting, abstracts at international conferences and use of webinars and social media to share results in a lay person-accessible executive summary, we have communicated our findings widely to many key audiences. [9][10][11]17,18 4) co-presentation of research findings locally and globally. Although these practices may seem obvious, there are still plenty of reports of parachute science, 19 poor collaborative practices and limited engagement with data collectors and clinicians at the frontlines of care.…”

“…Additionally, a specialised training was focused on Dubowitz scoring for gestational age assessment at birth. 11 Finally, through the creation of a Publications Committee with an amalgamation of ICMJE and institutional rules, we were able to create a venue for Principal Investigators and each partner to put forth ideas for manuscript development, engage on manuscript writing, agree on authorship and writing timelines, and hold each other accountable to study goals and outputs. The Publications Committee met every 6-8 weeks with representation from the Principal Investigators in India, Malawi, Tanzania and the USA.…”

“…The use of Dubowitz scoring to assess gestational age at the time of birth was acceptable to providers and had high agreement during training between trainers and trainees. 11 However, after implementation of the Dubowitz exam and best obstetric estimate algorithm, only 1.4% of gestational age determination was based on the Dubowitz score. This experience highlighted key challenges in enrolling a cohort of low birthweight infants with limitations in accurate and standardised estimation practices and documentation of gestational age during pregnancy.…”