Knowledge and Skills Retention Among Frontline Health Workers: Community Maternal and Newborn Health Training in Rural Ethiopia

Abstract

Introduction We examined the degree to which the skills and knowledge of health workers in Ethiopia were retained 18 months after initial maternal and newborn health training and sought to identify factors associated with 18‐month skills assessment performance. Methods A nonexperimental, descriptive design was employed to assess 18‐month skills performance on the topics of Prevent Problems Before Baby Is Born and Prevent Problems After Baby Is Born. Assessment was conducted by project personnel who also received the maternal and newborn health training and additional training to reliably assess health worker performance. Results Among the 732 health workers who participated in maternal and newborn health training in 6 rural districts of the Amhara and Oromia regions of Ethiopia (including pretesting before training and a posttraining posttest), 75 health extension workers (78%) and 234 guide team members (37%) participated in 18‐month posttest. Among health extension workers in both regions, strong knowledge retention was noted in 10 of 14 care steps for Prevent Problems Before Baby Is Born and in 14 of 16 care steps of Prevent Problems After Baby Is Born. Lower knowledge retention was observed among guide team members in the Amhara region. Across regions, health workers scored lowest on steps that involved nonaction (eg, do not give oxytocin). Educational attainment and age were among the few variables found to significantly predict test performance, although participants varied substantially by other sociodemographic characteristics. Discussion Results demonstrated an overall strong retention of knowledge and skills among health extension workers and highlighted the need for improvement among some guide team members. Refresher training and development of strategies to improve knowledge of retention of low‐performing steps were recommended.

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

“…Ten (22.2%) of the 45 studies reported a breakdown of scores according to cadre, 26,36,39,40,44,50,53,55,56,74 and 7 (70.0%) of these studies showed that birth attendants from lower cadres (eg, midwives) improved significantly more from pretraining to posttraining than those from higher cadres (eg, physicians). 26,40,42,50,53,56,74 In all 7 of these studies, significant differences in pretraining test performance between different cadres were diminished or completely eliminated upon retesting after training.…”

“…41,52,55,67 Furthermore, 4 (80%) of the 5 studies showing no falloff or mixed results featured refresher training or regular meetings to reinforce material learned. 43,52,55,67 Two of the studies with refresher courses showed an actual increase in knowledge and skills at 1 year and 18 months after training, respectively, compared with immediately after training. 52 Of note, the 2 educational interventions from Ethiopia provided refresher training, but they also sought to educate women in the community and increase their demand for skilled maternal and newborn care, which may have been an important incentive for birth attendants to maintain their knowledge and skills.…”

“…37,38,48,56,66 Three studies (30.0%) showed no falloff 41,43,52 ; the 2 remaining studies (20.0%), both from Ethiopia, found varying levels of retention in different groups of birth attendants, with higher levels of training associated with less falloff. 55,67 These latter 5 studies showing either no falloff or mixed results included the 4 longest running studies in our literature review, ranging from 9 months to 2 years. 41,52,55,67 Furthermore, 4 (80%) of the 5 studies showing no falloff or mixed results featured refresher training or regular meetings to reinforce material learned.…”

“…55,67 These latter 5 studies showing either no falloff or mixed results included the 4 longest running studies in our literature review, ranging from 9 months to 2 years. 41,52,55,67 Furthermore, 4 (80%) of the 5 studies showing no falloff or mixed results featured refresher training or regular meetings to reinforce material learned. 43,52,55,67 Two of the studies with refresher courses showed an actual increase in knowledge and skills at 1 year and 18 months after training, respectively, compared with immediately after training.…”

“…52 Of note, the 2 educational interventions from Ethiopia provided refresher training, but they also sought to educate women in the community and increase their demand for skilled maternal and newborn care, which may have been an important incentive for birth attendants to maintain their knowledge and skills. 55,67 The 1 study that found no falloff of skills over 9 to 12 months after training despite having no refresher training was conducted in 1 of Ghana's main referral institutions. 41 The high birth volume at this center may have prevented falloff by providing birth attendants with frequent clinical practice.…”