Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania

Makene, Christina; Plotkin, Marya; Currie, Sheena; Bishanga, Dunstan R.; Ugwi, Patience; Louis, Henry; Winani, Kiholeth; Nelson, Brett D.

doi:10.1186/preaccept-5559348291243054

Cited by 11 publications

(16 citation statements)

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“…[33][34][35] In our study, the difference between the higher prevalence of provision of signal functions and higher quality of services in EmOC compared with EmNC was due to the lack of two signal functions: KMC and provision of corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

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Section: Discussionmentioning

confidence: 99%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…18,36,39,48,59,62 All but 1 of these studies showed that significantly increased BMV use (83.3%) persisted after training compared with before training; however, application of this life-saving maneuver was far from universal, and the technique was often incorrect. In a study from Tanzania's HBB program, only 21.5% of trained participants correctly demonstrated all 3 maneuvers to improve BMV 6 weeks after training.…”

Section: Retention Of Bmv Skillsmentioning

confidence: 99%

“…36,37,43,44,59 Of these, 4 studies (80.0%) found that high or low test scores accurately predicted clinical behavior, 37,43,44,59 and only 1 study (20.0%) reported improved test scores but reduced use of stimulation and longer time to BMV initiation in the delivery room at 7 months after training. 36 Nine studies (20%) attempted to correlate performance on either standardized tests or actual behavior in the delivery room with changes in neonatal mortality statistics, and the results were mixed.…”

Section: Impact Of Theoretical Knowledge On Delivery Room Behaviors Amentioning

confidence: 99%

“…25, 36, 38, 39, 48, 49, 59, 61, 62, 71, 73 -75 Sixteen studies (35.6%) evaluated clinical behavior in the delivery room in addition to, or instead of, testing birth attendants in simulated scenarios. In 10 (62.5%) of these studies, examiners directly observed birth attendants, 18,30,31,36,43,44,59,64,65 whereas in 7 studies (43.8%), scores were based on chart review or recall by birth attendants and/or the newborn's mother. 37,43,47,50,57,60,62 One study both directly observed birth attendants and surveyed community women cared for by these attendants.…”

Section: Description Of Articlesmentioning

confidence: 99%

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Newborn Resuscitation Training in Resource-Limited Settings: A Systematic Literature Review

et al. 2016

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CONTEXT: Birth asphyxia contributes substantially to neonatal mortality in low-and middleincome countries (LMICs). The effects of training birth attendants in neonatal resuscitation (NR) on mortality are limited by falloff of skills and knowledge over time and transference of learned skills into clinical practice.OBJECTIVE: This review examined acquisition and retention of NR knowledge and skills by birth attendants in LMICs and the effectiveness of interventions to improve them.DATA SOURCES: Medline, Cochrane, Embase, CINAHL, Bireme, and African Index Medicus databases were searched. We reviewed Web pages and reports from non-peer-reviewed (or "gray") literature sources addressing NR training in LMICs. STUDY SELECTION:Articles on acquisition and retention of NR knowledge and skills, and interventions to improve them, were limited to LMICs. RESULTS:The initial search identified 767 articles, of which 45 met all inclusion criteria. Of these, 31 articles analyzed acquisition of knowledge and skills, and 19 analyzed retention. Most studies found high acquisition rates, although birth attendants struggled to learn bag-mask ventilation. Although significant falloff of knowledge and skills occurred after training, refresher training seemed to improve retention. Results of the gray literature analysis suggest that formal, structured practice sessions improve retention. LIMITATIONS: This review did not analyze training's direct impact on mortality.CONCLUSIONS: Knowledge and skills falloff is a significant barrier to the success of NR training programs and possibly to reducing newborn mortality in LMICs. Refresher training and structured practice show significant promise. Additional research is needed to implement and assess retention improvement strategies in classroom and clinical settings.a Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; b Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; c Harvard Medical School, Boston, Massachusetts; and d Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah Dr Reisman oversaw the literature reviews, interpreted the results, and drafted the initial manuscript; Ms Arlington assisted with the gray literature search and reviewed and revised the manuscript; Dr Jensen performed the initial gray literature analysis and reviewed and revised the manuscript; Mr Louis and Ms SuarezRebling conducted the initial literature review; and Dr Nelson conceptualized and designed the literature review and reviewed and revised the manuscript. All authors approved the fi nal manuscript as submitted.

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“…Similarly, a pre-post study in Tanzania found significant improvements in health worker knowledge of neonatal resuscitation yet skills did not improve. 33 This suggests that improved knowledge alone is insufficient to ensure the adoption of guidelines.…”

Section: Discussionmentioning

confidence: 99%

“You have to take action”: changing knowledge and attitudes towards newborn care practices during crisis in South Sudan

Sami

Kerber

Tomczyk

et al. 2017

Reproductive Health Matters

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Highest rates of neonatal mortality occur in countries that have recently experienced conflict. International Medical Corps implemented a package of newborn interventions in June 2016, based on the Newborn health in humanitarian settings: field guide, targeting community-and facility-based health workers in displaced person camps in South Sudan. We describe health workers' knowledge and attitudes toward newborn health interventions, before and after receiving clinical training and supplies, and recommend dissemination strategies for improved uptake of newborn guidelines during crises. A mixed methods approach was utilised, including pre-post knowledge tests and in-depth interviews. Study participants were community-and facility-based health workers in two internally displaced person camps located in Juba and Malakal and two refugee camps in Maban from March to October 2016. Mean knowledge scores for newborn care practices and danger signs increased among 72 community health workers (pretraining: 5. . Knowledge and attitudes toward key essential practices, such as the use of partograph to assess labour progress, early initiation of breastfeeding, skin-to-skin care and weighing the baby, improved among skilled birth attendants. Despite challenges in conflict-affected settings, conducting training has the potential to increase health workers' knowledge on neonatal health post-training. The humanitarian community should reinforce this knowledge with key actions to shift cultural norms that expand the care provided to women and their newborns in these contexts.

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Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania

Cited by 11 publications

References 10 publications

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Newborn Resuscitation Training in Resource-Limited Settings: A Systematic Literature Review

“You have to take action”: changing knowledge and attitudes towards newborn care practices during crisis in South Sudan

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