Effectiveness of clinical training on improving essential newborn care practices in Bossaso, Somalia: a pre and postintervention study

Abstract

Background: Increasingly, neonatal mortality is concentrated in settings of conflict and political instability. To promote evidence-based practices, an interagency collaboration developed the Newborn Health in Humanitarian Settings: Field Guide. The essential newborn care component of the Field Guide was operationalized with the use of an intervention package encompassing the training of health workers, newborn kit provisions and the installation of a newborn register. Methods: We conducted a quasi-experimental prepost study to test the effectiveness of the intervention package on the composite outcome of essential newborn care from August 2016 to December 2018 in Bossaso, Somalia. Data from the observation of essential newborn care practices, evaluation of providers' knowledge and skills, postnatal interviews, and qualitative information were analyzed. Differences in two-proportion z-tests were used to estimate change in essential newborn care practices. A generalized estimating equation was applied to account for clustering of practice at the health facility level. Results: Among the 690 pregnant women in labor who sought care at the health facilities, 89.9% (n = 620) were eligible for inclusion, 84.7% (n = 525) were enrolled, and newborn outcomes were ascertained in 79.8% (n = 419). Providers' knowledge improved from pre to posttraining, with a mean difference in score of + 11.9% (95% CI: 7.2, 16.6, p-value < 0.001) and from posttraining to 18-months after training with a mean difference of + 10.9% (95% CI: 4.7, 17.0, p-value < 0.001). The proportion of newborns who received two or more essential newborn care practices (skin-to-skin contact, early breastfeeding, and dry cord care) improved from 19.9% (95% CI: 4.9, 39.7) to 94.7% (95% CI: 87.7, 100.0). In the adjusted model that accounted for clustering at health facilities, the odds of receiving two or more essential newborn practices was 64.5 (95% CI: 15.8, 262.6, p-value < 0.001) postintervention compared to preintervention. Predischarge education offered to mothers on breastfeeding 16.5% (95% CI: 11.8, 21.1) vs 44.2% (95% CI: 38.2, 50.3) and newborn illness danger signs 9.1% (95% CI: 5.4, 12.7) vs 5.0% (95% CI: 2.4, 7.7) remained suboptimal.

Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study

“…Our results are consistent with those of Bang et al and Drake et al who documented that ongoing training programmes are more effective and necessitated, as these can improve knowledge and skill retention, especially in resource-limited countries ( 22 , 27 ). A pre- and post-intervention study testing a long-term newborn training programme in Somalia over a two-and-a-half-year period (including an 18-month follow-up) demonstrated that some skills did not improve ( 28 ). Issues such as hand hygiene and discharge education did not improve over time, and the authors suggested that different training approaches were needed to address the local needs.…”

The shadow challenges to improve the state essential newborn care practices in healthcare providers: evidence from a multicentre cross-sectional study in Ethiopia

“…This finding is congruent with the previous studies [ 5 , 17 ]. This can be explained by healthcare providers who took essential newborn care training or courses that can ensure the skills and knowledge to provide up-to-date evidence-based information and management for a range of needs in the initial newborn period [ 22 – 24 ].…”

Study on outcome of guided newborn care in postnatal ward and common practices of newborn care among mothers followed in outpatient department at Hi-Tech medical college and hospital, Bhubaneswar

“…Early rooming-in and skin-to-skin within 1 hour of life after birth provides optimal thermal care, encourages breastfeeding, enhances bonding and good for mother's wellbeing as it helps control intrapartum bleeding. 5,[9][10][11]…”

“…Dry cord care is recommended, however in high mortality settings, chlorhexidine is recommended. 6,[9][10][11] exclusive breastfeeding for 6 months. Breastfeeding should be continued with safe complementary foods after 6 months.…”