Skills retention in Sudanese village midwives 1 year following Helping Babies Breathe training

Arabi, Ali; Ibrahim, Safaa A.; Ahmed, S; MacGinnea, Finn; Hawkes, Gavin A.; Dempsey, Eugene M.; Ryan, C. Anthony

doi:10.1136/archdischild-2015-309190

Cited by 30 publications

(32 citation statements)

References 13 publications

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“…The decline in skills we observed after the first four months is consistent with previous research [9,10]. The most effective method to refresh these skills, however, has yet to be determined.…”

Section: Discussionsupporting

confidence: 92%

“…A final limitation of this study is that the simulation examinations were administered and scored by four different individuals, without evaluating for inter-rater variation such as in a study from Sudan [10]. However, as the OSCE remains consistent across time and among all study subjects, and all evaluators received the same HBB Master Trainer course, it is not surprising that the Sudanese study found strong inter-rater agreement, and therefore this did not likely significantly alter our results.…”

Section: Discussionmentioning

confidence: 99%

“…However, evidence also suggests performance decreases significantly over time when learners are not provided with ongoing refresher training [9,10]. Research has demonstrated improvement in skills after various types of refresher courses [7–10], but consensus has yet to be reached for the ideal timing and duration for such education.…”

Section: Introductionmentioning

confidence: 99%

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Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Eblovi

Kelly

Afua

et al. 2017

Global Health Action

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Background: The Helping Babies Breathe (HBB) program teaches basic newborn resuscitation techniques to birth attendants in low-resource settings. Previous studies have demonstrated a decrease in mortality following training, mostly in large hospitals. However, low-volume clinics in rural regions with no physician immediately available likely experience a greater relative burden of newborn mortality. This study aimed to determine the impact of HBB trainings provided to rural Ghanaian midwives on their skills retention and on first 24 hour mortality of the newborns they serve. Methods: American Acadamy of Paediatrics (AAP)-trained Master Trainers conducted two 2-day HBB trainings and 2-day refresher courses one year later for 48 midwives from Ghanaian rural health clinics. Trainee skills were evaluated by Objective Structured Clinical Examination (OSCE) at three time points: immediately after training, four months after training, and four months after the refresher. Midwives recorded the single highest level of resuscitation performed on each newborn delivered for one year. Results: 48 midwives attended the two trainings, 32 recorded data from 2,383 deliveries, and 13 completed OSCE simulations at all three time points. The midwives’ OSCE scores decreased from immediately after training (94.9%) to four months later (81.2%, p < 0.00001). However, four months following the refresher course, scores improved to the same high level attained initially (92.7%, p = 0.0013). 5.0% of neonates required bag-mask ventilation and 0.71% did not survive, compared with a nationwide first 24 hour mortality estimate of 1.7%. Conclusions: The midwives’ performance on the simulation exercise indicates that an in-depth refresher course provided one year after the initial training likely slows the decay in skills that occurs after initial training. Our finding that 5.0% of newborns required bag-mask ventilation is consistent with global estimates. Our observed first 24 hour mortality rate of 0.71% is lower than nationwide estimates, indicating the training likely prevented deaths due to birth asphyxia.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Eblovi

Kelly

Afua

et al. 2017

Global Health Action

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“…Single training sessions have been associated with adequate skills retention [9,34]; however, frequent brief on-site sessions were shown to retain skills as well as improve the clinical outcomes of resuscitated babies [6]. Midwives reported that more practical training would increase their knowledge, skills, competence and confidence in performing ventilation.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania

Moshiro

Ersdal

Mdoe

et al. 2018

Global Health Action

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Background: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers. Objective: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania. Methods: Eight midwives, each with more than one year’s working experience in the labour ward, were interviewed individually at Haydom Lutheran Hospital, Tanzania. The audio recordings were transcribed and translated into English and analysed using qualitative content analysis. Results: Midwives reported the ability to monitor labour properly, preparing resuscitation equipment before delivery, teamwork and frequent ventilation training as the most effective factors in improving actual ventilation practices and promoting the survival of newborns. They thought that their anxiety and fear due to stress of ventilating a non-breathing baby often led to poor resuscitation performance. Additionally, they experienced difficulties assessing the baby’s condition and providing appropriate clinical responses to initial interventions at birth; hence, further necessary actions and timely initiation of ventilation were delayed. Conclusions: Efforts should be focused on improving labour monitoring, birth preparedness and accurate assessment immediately after birth, to decrease intrapartum-related hypoxia. Midwives should be well prepared to treat a non-breathing baby through high-quality and frequent simulation training with an emphasis on teamwork training.

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“…In a previous study, we showed that a selection of Sudanese VMWs acquired and retained resuscitation skills for up to a year following HBBT plus regular peer–peer skills practice (HBBT +RPPSP ) 16. The purpose of this paper was to present findings related to newborn resuscitation practices, FSB and first-week ENND in the same cohort of VMWs before and after HBBT +RPPSP .…”

Section: Introductionmentioning

confidence: 90%

Perinatal outcomes following Helping Babies Breathe training and regular peer–peer skills practice among village midwives in Sudan

et al. 2017

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BackgroundOver 80% of deliveries in Sudan occur in rural areas, attended by village midwives (VMWs).ObjectiveTo determine the impact of Helping Babies Breathe training and regular peer–peer skills practice (HBBT+RPPSP) on VMW resuscitation practices and outcomes.MethodsIn a prospective community-based intervention study, 71/82 VMWs, reporting to six East Nile rural medical centres, with previous experience in community health research, consented to HBBT+RPPSP. Outcomes included changes in the resuscitation practices, fresh stillbirths (FSB) and early neonatal deaths <1 week (ENND).ResultsThere were 1350 and 3040 deliveries before and after HBBT+RPPSP, respectively, with no significant differences between the two cohorts regarding maternal age, education or area of birth. Drying of the newborn increased almost tenfold (8.4%, n=113 to 74.9%, n=1011) while suctioning of the mouth/nose decreased fivefold (80.3%, n=2442 to 14.4%, n=437) following HBBT+RPPSP. Pre-HBBT+RPPSP9/18 (50%) newborns who had mouth-to-mouth ventilation died, compared with 13/119 (11%) who received bag-mask ventilation post-HBBT+RPPSP. Excluding 11 macerated fetuses, there were 55 perinatal deaths: 14 FSB/18 ENND (6 months pre-HBBT+RPPSP) and 10 FSB/13 ENND (18 months post-HBBT+RPPSP). FSB rates decreased from 10.5 to 3.3 per 1000 births ((χ2)=8.6209, p=0.003), while ENND rates decreased from 13.5 to 4.3 per 1000 live births ((χ2)=10.9369, p=0.001) pre-HBBT+RPPSP and post-HBBT+RPPSP, respectively.ConclusionIn a selected group of VMWs, HBBT+RPPSP was associated with improvements in newborn resuscitation and perinatal outcomes. HBBT+RPPSP could have immense benefits if propagated nationally to all 17 000 VMWs in Sudan.

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Skills retention in Sudanese village midwives 1 year following Helping Babies Breathe training

Abstract: VMWs, despite a high illiteracy rate, absorbed and sustained HBB skills for at least a year. Regular, low intensity, manikin-based skills training with peers may have helped sustain FMV, but not hand-cleansing skills.

Cited by 30 publications

References 13 publications

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania

Perinatal outcomes following Helping Babies Breathe training and regular peer–peer skills practice among village midwives in Sudan

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