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

Abstract

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.

Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained: An observational study

“…It is clear that knowledgeable care providers can apply their knowledge to skill. Paradoxically, receiving NR refresher training was not associated with the multivariate logistic analysis of this study, but in many studies, NR training was found to be significantly associated with retention of NR skill [23,30,[50][51][52][53][54][55].…”

Frequent refresher training on newborn resuscitation and potential impact on perinatal outcome over time in a rural Tanzanian hospital: an observational study

“…The HBB refresher training involved all the staff responsible for attending births/resuscitations, reinforcing the existing frequent brief training programme, which we have shown to be associated with a reduction in mortality 12. This addresses the concern raised by Makene et al and Eblovi et al on the necessity for on-job practice and strengthening of supportive supervision to ensure quality in resuscitation 34 35…”

Helping Babies Breathe, Second Edition: A Model for Strengthening Educational Programs to Increase Global Newborn Survival

“… 15 , 24 , 34 – 36 However, published reports also mentioned the deterioration of skills after HBB workshops, which mirrored the experiences of other resuscitation training programs. 24 , 37 , 38 For the effective performance of these lifesaving skills to impact neonatal mortality and stillbirth rates, providers need to be able to perform basic resuscitation and bag-mask ventilation, if needed, within “The Golden Minute” after birth.…”

“…The concept of ongoing practice, even when studied in rural providers—such as village midwives and birth attendants—1 year after their initial HBB training, showed retention of basic resuscitation skills with ongoing practice and/or refresher trainings and reductions in fresh stillbirth and early neonatal mortality rates. 38 , 42 , 43 …”