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

Clark, Robert B.; Dhungana, Ranjan P; Chalise, Mala; Visick, Michael K.

doi:10.1177/10105395231185992

Cited by 3 publications

(3 citation statements)

References 17 publications

(24 reference statements)

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“…Rowe et al ’s research presents inconclusive evidence on whether protocol training or clinical acumen training more effectively improves provider competence 66. Similarly, Clark et al ’s study demonstrates improved healthcare outcomes from neonatal resuscitation training combined with ongoing mentorship and skill reinforcement 68. However, it remains to be determined whether skill practice directly strengthens provider competence or mainly supports continuous education and refresher training.…”

Section: Discussionmentioning

confidence: 99%

“… 66 Similarly, Clark et al ’s study demonstrates improved healthcare outcomes from neonatal resuscitation training combined with ongoing mentorship and skill reinforcement. 68 However, it remains to be determined whether skill practice directly strengthens provider competence or mainly supports continuous education and refresher training. Ayeiko et al ’s work, showing significant care quality improvements in young hospitalised children through active feedback and mentorship, suggests an alternative approach to intensive skill maintenance.…”

Section: Discussionmentioning

confidence: 99%

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Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

Meaney,

Hokororo,

Ndosi

et al. 2024

BMJ Open

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IntroductionTo improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition.Methods6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.ResultsaESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1–9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%–63%), unconscious-incompetence 32% (IQR: 23%–42%), conscious-incompetence 7% (IQR: 2%–15%), and unconscious-competence 2% (IQR: 0%–3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity.ConclusionaESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

Meaney,

Hokororo,

Ndosi

et al. 2024

BMJ Open

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“…The active coaching and mentorship averaged about 15 months per hospital during the 4 years period. Details on programme design are presented elsewhere [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

An assessment of immediate newborn care readiness and availability in Nepal

Dhungana,

Chalise,

Clark

2023

Global Health Action

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Background Global neonatal mortality necessitates access to immediate newborn care interventions. In Nepal, disparities persist in the readiness and availability of newborn care services within health facilities. Objective This study aimed to assess this status and compare facilities that had implemented an intensive newborn resuscitation capacity building and retention programme in the past five years with those that had not. Methods Our observational cross-sectional study involved 154 health facilities across Nepal. Through on-site inspections and maternal log reviews, we evaluated the immediate newborn care readiness and availability. Results The mean immediate newborn care intervention availability score of 52.8% (SE = 21.5) and the readiness score averaged 79.6% (SE = 12.3). Encouragingly, 96% of facilities ensured newborns were dried and wrapped for warmth, and 69.9% provided newborn resuscitation. Practices such as delayed cord clamping (42.0%), skin-to-skin contact (28.6%), and early breastfeeding (63.5%) showed room for improvement. Only 16.1% of health facilities administered Vitamin K1 prophylaxis.Domain-specific scores demonstrated a high level of facility readiness in infrastructure (97.5%), medicine, equipment, and supplies (90.6%), and staff training (90.9%), but a lower score for neonatal resuscitation aids (28.8%). Disparities in readiness and availability were evident, with rural areas and the Madhesh province reporting lower scores. Variations among health facility types revealed provincial and private hospitals outperforming local-level facilities. A positive association was observed between the LDSC/SSN mentoring programme and both the readiness and availability of immediate newborn care services. Conclusion This study highlights the gap between healthcare facility readiness and the actual availability of immediate newborn care interventions in Nepal. Addressing disparities and barriers, particularly in rural areas and local-level facilities, is crucial for improving neonatal survival. The positive link between the LDSC/SSN programme and service availability and facility readiness emphasises the significance of targeted training and mentorship programmes in enhancing newborn care across Nepal.

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Midwives’ attitudes, motivations, and barriers to neonatal resuscitation in a tertiary hospital, Ghana: A qualitative inquiry

Agbenohevi,

Ani-Amponsah,

Donkor

et al. 2024

Journal of Neonatal Nursing

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

Cited by 3 publications

References 17 publications

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

An assessment of immediate newborn care readiness and availability in Nepal

Midwives’ attitudes, motivations, and barriers to neonatal resuscitation in a tertiary hospital, Ghana: A qualitative inquiry

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