Effect of a low-dose, high-frequency training approach on stillbirths and early neonatal deaths: a before-and-after study in 12 districts of Uganda

Abstract

Background Post-partum haemorrhage and neonatal asphyxia are the leading causes of maternal and newborn deaths, respectively, in Uganda. However, proven interventions that can save the lives of women and children are not being widely practised. Here, we assess the effects of two onsite training programmes for interventions to reduce deaths from post-partum haemorrhage and neonatal asphyxia, plus three different levels of performance support after the training in health-care facilities in 12 districts of Uganda. Methods We invited all public and some private non-profit health facilities that deliver babies in western and eastern regions of Uganda to participate. At all study sites, training in the Helping Mothers Survive and Helping Babies Breathe interventions was given to all health-care providers who attend births-medical doctors, clinical officers, midwives, nurses, and nurse assistants. The training consisted of low-dose, high-frequency onsite training followed by 20 weeks of provider-led practise with low-cost simulators. At all intervention sites, a midwife was designated as a clinical mentor or peer leader of simulation-based practice. We used a cluster randomised design to match districts for volume of births and presence of an operating theatre, and then randomly allocated districts to one of three training follow-up groups. A full-support group had onsite training supported with a peer practice coordinator and weekly practice sessions, supplemented with mobile messages to remind providers to practise. A partial-support group had an onsite training programme supported with a peer practice coordinator; and a control group received onsite training only. We collected routine monthly service-delivery statistics from the government Integrated Maternity Register (IMR) and introduced a supplemental maternity register to capture indicators not present in the IMR. Outcomes of interest were fresh stillbirths and neonatal deaths within 24 h at baseline and 6 months after the intervention. We had also aimed to study post-partum haemorrhage retained placenta, but no baseline data were available. Findings Between May, 2013, and May, 2016, training was delivered at 125 participating health facilities: 11 hospitals, 21 level IV health centres, 79 level III health centres, and 14 level II health centres. The control and partial-support groups had three hospitals each, but the full group had five hospitals, including the only regional referral hospital. The partial-support group had more level III and II (n=35) hospitals than did the full-support and control groups (n=29 each). The proportion of adverse birth outcomes (combined fresh stillbirths and neonatal deaths within 24 h), appeared to decrease significantly in all the study groups from baseline to 6 months post intervention: from 26•5 to 9•6 per 1000 livebirths (p<0•001) in the full support group, from 24•2 to 7•8 per 1000 livebirths (p<0•001) in the partial-support group, and from 17•2 to 9•5 per 1000 livebirths in the control group (p=0•008). We also noted a 47% r...

Structured on-the-job training to improve retention of newborn resuscitation skills: a national cohort Helping Babies Breathe study in Tanzania

“…These factors were absent from the design of the initial training approach, which despite providing instructions for participants to continue practicing with simulation, lacked any structured tool to reinforce that behaviour. Our findings also support the importance of workplace-based practice, consistent with other published work [6, 21] as well as repeated exposure to learning interventions to improve knowledge and skills retention [22].…”

Building a Learner Model for a Smartphone-Based Clinical Training Intervention in a Low-Income Context: A Pilot Study

“…Relation To Other Studies The emphasis of emergency care training in low resource settings to use low-dose highfrequency (LDHF) training is not new but has been recently introduced in SSA [36]. Our findings support this approach by demonstrating how learning gains are most improved where the opportunity to learn is high.…”

“…How different clinical training intervention use metacognitive scaffolds to improve knowledge gains is not new [37][38][39], but hardly present in research from low resource settings [18]. Moreover, while using adaptive learning demonstrates significantly better knowledge gains than alternatives [37][38][39], the current LDHF training models -which are not adaptive to individual learner needs-are still the most commonly implemented models of learning, usually face-to-face, and at a very high cost [15,16,36]. This study further explores how the use of smartphone devices to deliver clinical training using short simulation-based learning activities, can begin to accommodate self-regulated learning over time, which have been show to optimise learning in similar settings [40].…”

eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings

“…[14][15][16][17][18][19] For this reason, periodic refresher training with 'low-dose high frequency' manikin-based simulations are recommended to support neonatal resuscitation skills retention. 20 21 Unfortunately, access to manikin-based simulation is limited by trainer, space and equipment availability. 22 23 Yet, the high penetration of smartphones and cellular network connectivity in urban and rural areas in LMICs, makes innovative simulation training feasible using mobile virtual reality (VR) simulations for healthcare workers (HCWs) who provide care in health facility and community-based settings.…”