Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan

Mubeen, Kiran; Baig, Marina; Abbas, Sadia; Adnan, Farzana; Lakhani, Arusa; Bhamani, Shireen Shehzad; Rehman, Bushra; Shahid, Shahnaz; Jan, Rafat

doi:10.1186/s12887-021-03014-2

Cited by 8 publications

(10 citation statements)

References 22 publications

(29 reference statements)

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“…Additional follow-up interventions to prevent skill deterioration over time included group practice sessions, on-site coaching, self-evaluation forms, and unit/team meetings. Studies of follow-up interventions such as frequent refresher training and on-the-job practice have demonstrated improved retention of knowledge and skills and remarkable improvement in neonatal mortality outcomes, 23 as also observed in this evaluation. The innovative approach in which facility-based trainers and external Mentors were the drivers for achieving program goals was also a strength of the program.…”

Section: Discussionsupporting

confidence: 70%

“…training and on-the-job practice have demonstrated improved retention of knowledge and skills and remarkable improvement in neonatal mortality outcomes, 23 as also observed in this evaluation. The innovative approach in which facilitybased trainers and external Mentors were the drivers for achieving program goals was also a strength of the program.…”

Section: Studies Of Follow-up Interventions Such As Frequent Refreshersupporting

confidence: 76%

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Scale Up of Neonatal Resuscitation Training and Skill Retention in Five Provinces of Nepal

Clark

Dhungana²,

Chalise³

et al. 2023

Asia Pac J Public Health

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To reduce neonatal mortality attributable to intrapartum hypoxic events, Latter-days Saint Charities (LDSC) and Safa Sunaulo Nepal (SSN) implemented a neonatal resuscitation training, scale-up, and skill retention program. This article reports on the LDSC/SSN dissemination program and newborn outcomes associated with its implementation. To evaluate the program, we used a prospective cohort design to compare outcomes of birth cohorts in 87 health facilities preimplementation and postimplementation of the facility-based training. A paired T-test was used to determine whether baseline and endline values were significantly different. Resuscitation training began with trainers from 191 facilities attending Helping Babies Breathe (HBB) training-of-trainer (ToT) courses. Thereafter, 87 facilities from five provinces received active mentoring, scale-up assistance (6389 providers trained), and skill retention support. The LDSC/SSN program was associated with decreases in the number of intrapartum stillbirths in all provinces except Bagmati. Neonatal deaths within 24 hours of birth decreased significantly in Lumbini, Madhesh, and Karnali provinces. Morbidity associations, as defined by sick newborn transfers, decreased significantly in Lumbini, Gandaki, and Madhesh provinces. The LDSC/SSN model of neonatal resuscitation training, scale-up, and skill retention has the potential to significantly improve perinatal outcomes. It could potentially guide future programs in Nepal and other resource-limited settings.

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Section: Discussionsupporting

confidence: 70%

Section: Studies Of Follow-up Interventions Such As Frequent Refreshersupporting

confidence: 76%

Scale Up of Neonatal Resuscitation Training and Skill Retention in Five Provinces of Nepal

Clark

Dhungana²,

Chalise³

et al. 2023

Asia Pac J Public Health

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“…Skills retention remains a significant challenge for sustainability of impact of initial HBB training. Refresher trainings and increased supervision are strategies that have been shown to improve retention [ 16 , 20 , 37 ]; however, these methods are resource intensive. Technology based solutions that are integrated into daily routines of users, such as mobile apps like HBB Prompt, enhanced manikins like “NeoNatalie Live” [ 34 , 36 ] or VR technology like eHBB [ 34 ] may provide feasible solutions that are more easily scalable.…”

Section: Discussionmentioning

confidence: 99%

Utilization of a novel mobile application, “HBB Prompt”, to reduce Helping Babies Breathe skills decay

Chan

Merali

Mistry

et al. 2023

PLOS Glob Public Health

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Background Helping Babies Breathe (HBB) is a newborn resuscitation training program designed to reduce neonatal mortality in low- and middle-income countries. However, skills decay after initial training is a significant barrier to sustained impact. Objective To test whether a mobile app, HBB Prompt, developed with user-centred design, helps improve skills and knowledge retention after HBB training. Methods HBB Prompt was created during Phase 1 of this study with input from HBB facilitators and providers from Southwestern Uganda recruited from a national HBB provider registry. During Phase 2, healthcare workers (HCWs) in two community hospitals received HBB training. One hospital was randomly assigned as the intervention hospital, where trained HCWs had access to HBB Prompt, and the other served as control without HBB Prompt (NCT03577054). Participants were evaluated using the HBB 2.0 knowledge check and Objective Structured Clinical Exam, version B (OSCE B) immediately before and after training, and 6 months post-training. The primary outcome was difference in OSCE B scores immediately after training and 6 months post-training. Results Twenty-nine HCWs were trained in HBB (17 in intervention, 12 in control). At 6 months, 10 HCW were evaluated in intervention and 7 in control. In intervention and control respectively, the median OSCE B scores were: 7 vs. 9 immediately before training, 17 vs. 21 immediately after training, and 12 vs. 13 at 6 months after training. Six months after training, the median difference in OSCE B scores was -3 (IQR -5 to -1) in intervention and -8 (IQR -11 to -6) in control (p = 0.02). Conclusion HBB Prompt, a mobile app created by user-centred design, improved retention of HBB skills at 6 months. However, skills decay remained high 6 months after training. Continued adaptation of HBB Prompt may further improve maintenance of HBB skills.

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“…The model focused on the role of an external mentor assisting the facility-based trainers in cascading HBB training to all providers; and holding practice sessions, on-site coaching, and refresher trainings. Evidence from low and middle-income countries demonstrated that HBB training with frequent refresher training and on-the-job practice can positively impact the retention of knowledge and skills on newborn resuscitation and yield remarkable improvement in neonatal mortality outcomes(40).…”

Section: Discussionmentioning

confidence: 99%

Assessing the effectiveness of newborn resuscitation training and skill retention program on neonatal outcomes in Madhesh Province, Nepal

Chalise¹,

Dhungana²,

Visick

et al. 2022

Preprint

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Background Intrapartum events leading to asphyxia at birth is one of the leading causes of neonatal morbidity and mortality in Nepal. In response to this, the Nepal Ministry of Health and Population adopted Helping Babies Breathe (HBB) as a tool to improve neonatal resuscitation. The effectiveness of HBB trainings in developing newborn resuscitation knowledge and skills of service providers have been well established. However, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN), with support from LDS Charities designed an initiative for scaling up newborn resuscitation training and maintaining skills over time. This paper reports on the implementation of SSN’s model of newborn resuscitation trainings and skill retention, and changes in perinatal outcomes that occurred during the program. Methods The program capacitated facility-based trainers for scale up and maintaining resuscitation skills in 20 facilities in Madhesh Province, Nepal. A single external mentor coached and assisted the facility-based trainers, provided general support, and monitored progress. Prospective outcome monitoring tracked changes in health metrics for a period of 14 months. To analyze changes over the time, the neonatal mortality, morbidity, and stillbirths at the baseline (first two months) of the program was compared with the endline (last two months) measures. Results Data was gathered on neonatal health outcomes of 68,435 vaginal deliveries and 9,253 cesarean sections. Results indicate decreases in <24 hours neonatal deaths (p<0.001), intrapartum stillbirths (p<0.001), and number of sick newborns transferred from the maternity unit (p<0.001). During the program, facility-based trainers taught resuscitation skills to 231 medical personnel and supported skill retention. Conclusions SSN’s model is a low-cost, evidence-based program focusing on facility-based trainers, who are mentored and supported to scale-up and sustain resuscitation skills over time. Findings from the report are suggestive that the model had a substantial influence on critical neonatal outcomes. Future programs focused on improving neonatal outcomes may benefit by incorporating program elements of SSN model.

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Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan

Cited by 8 publications

References 22 publications

Scale Up of Neonatal Resuscitation Training and Skill Retention in Five Provinces of Nepal

Scale Up of Neonatal Resuscitation Training and Skill Retention in Five Provinces of Nepal

Utilization of a novel mobile application, “HBB Prompt”, to reduce Helping Babies Breathe skills decay

Assessing the effectiveness of newborn resuscitation training and skill retention program on neonatal outcomes in Madhesh Province, Nepal

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