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Welsh J, Hounkpatin H, Gross MM, Hanson C, Moller AB. Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000-2020. BMC MEDICAL EDUCATION 2022; 22:725. [PMID: 36242024 PMCID: PMC9568981 DOI: 10.1186/s12909-022-03772-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Levels of maternal and neonatal mortality remain high in sub-Saharan Africa, with an estimated 66% of global maternal deaths occurring in this region. Many deaths are linked to poor quality of care, which in turn has been linked to gaps in pre-service training programmes for midwifery care providers. In-service training packages have been developed and implemented across sub-Saharan Africa in an attempt to overcome the shortfalls in pre-service training. This scoping review has aimed to summarize in-service training materials used in sub-Saharan Africa for midwifery care providers between 2000 and 2020 and mapped their content to the International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice. METHODS Searches were conducted for the years 2000-2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Science Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a search of grey literature from international organizations was also performed. Identified in-service training materials that were accessible freely on-line were mapped to the ICM Essential Competencies for midwifery practice. RESULTS The database searches identified 1884 articles after removing duplicates. After applying exclusion criteria, 87 articles were identified for data extraction. During data extraction, a further 66 articles were excluded, leaving 21 articles to be included in the review. From these 21 articles, six different training materials were identified. The grey literature yielded 35 training materials, bringing the total number of in-service training materials that were reviewed to 41. Identified in-service training materials mainly focused on emergency obstetric care in a limited number of sub-Saharan Africa countries. Results also indicate that a significant number of in-service training materials are not readily and/or freely accessible. However, the content of in-service training materials largely met the ICM Essential Competencies, with gaps noted in the aspect of woman-centred care and shared decision making. CONCLUSION To reduce maternal and newborn morbidity and mortality midwifery care providers should have access to evidence-based in-service training materials that include antenatal care and routine intrapartum care, and places women at the centre of their care as shared decision makers.
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Affiliation(s)
- Joanne Welsh
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Claudia Hanson
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
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Experiences of community midwives receiving helping baby breathe training through the low dose high-frequency approach in Gujrat, Pakistan. Midwifery 2021; 105:103241. [PMID: 34986433 DOI: 10.1016/j.midw.2021.103241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 11/14/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pakistan's neonatal mortality rate has the highest proportion in the South Asian region and it is higher in the rural areas as compared to the urban areas. Poor resuscitation techniques and lack of basic newborn resuscitation skills in birth attendants are contributing factors towards neonatal deaths. Based on the significant outcomes of the Helping Baby Breath (HBB) training, similar training was implemented for Community Midwives (CMWs) in a low-resource setting in Gujrat, Pakistan, to improve their knowledge and skills. The training evaluation was conducted and participant feedback was obtained through both qualitative and quantitative methods. The findings of the quantitative assessment of the training evaluation will be published elsewhere. This paper presents the qualitative evaluation of the training. OBJECTIVE The objective of the study was, to determine the perceptions of HBB trained CMWs about the effectiveness of the HBB training, and the challenges faced in the implementation of HBB skills for newborn resuscitation, at their work settings. METHODOLOGY The qualitative descriptive design was used in this study. The purposive sampling technique was chosen to recruit midwives and key informants as participants of the training. Interviews were conducted by using a semi-structured interview guide. The study included a total of five interviews: two focus group interviews for CMWs (10 in each group), and three individual interviews of key informants. FINDINGS The content analysis of the qualitative data yielded three themes: the effectiveness of training, challenges, and suggestions. The findings revealed that the HBB training was effective for the CMWs in terms of its usability, regarding improvement in newborn resuscitation knowledge and skills. Moreover, it enhanced confidence and satisfaction in CMWs. However, less volume of patients was a challenge for a few CMWs with regard to practicing their skills. CONCLUSION Due to the inadequate number of patients and fewer opportunities of practice for several CMWs, they required such training frequently, in order to maintain their competency. The CMWs also recommended that HBB training should be part of the Midwifery program curriculum. Moreover, similar training was also recommended for other healthcare providers working in low-resource settings, including doctors and nurses.
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Smith M, Leader A, Roa W, Jaramillo E, Lazala D, Flores J, Cadet C, Vazifedan T, Bentley S, Jensen L. Helping Mothers Survive: Program Evaluation and Early Outcomes of Maternal Care Training in the Dominican Republic. Front Public Health 2021; 9:660908. [PMID: 34222172 PMCID: PMC8242252 DOI: 10.3389/fpubh.2021.660908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/20/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers. Methods: An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia & eclampsia (PE&E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers. Results: Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016–August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents/interns, nurses, students, and “other.” A significant improvement in knowledge scores was observed for both the BAB and PE&E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&E virtual training pilot workshop in August 2020. Discussion/Conclusions: Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.
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Affiliation(s)
- Meghan Smith
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alexandra Leader
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Wanny Roa
- Region II, Ministry of Health, Santiago, Dominican Republic
| | - Ericka Jaramillo
- Family Medicine, Natividad Medical Center, Salinas, CA, United States
| | - Davina Lazala
- Region II, Ministry of Health, Santiago, Dominican Republic
| | - Jose Flores
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Claudia Cadet
- Department of Neonatology, WakeMed Health and Hospitals, Raleigh, NC, United States
| | - Turaj Vazifedan
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Suzanne Bentley
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Emergency Medicine, Elmhurst Hospital Center, Elmhurst, NY, United States
| | - Lloyd Jensen
- Department of Pediatrics, University of Nevada Las Vegas, Las Vegas, NV, United States
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Ding X, Wang L, Msellem MI, Hu Y, Qiu J, Liu S, Zhang M, Zhu L, Latour JM. Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study. Front Pediatr 2021; 9:693583. [PMID: 34262890 PMCID: PMC8273261 DOI: 10.3389/fped.2021.693583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Neonatal mortality rates remain high in Sub-Saharan African countries. Improving the newborn resuscitation skills of healthcare professionals is important in addressing this challenge. The aim of this study was to evaluate a neonatal resuscitation training programme delivered over a two-year period for healthcare professionals in Zanzibar, Tanzania. Methods: A pre- and post-intervention study was designed. We delivered neonatal resuscitation training over a 2-day period in 2017 and 2 days of refresher training in 2018. Knowledge was evaluated by a self-designed survey (11 items with a total score of 22) before and after the two training periods, and skills were evaluated by a skills checklist (six domains with 25 items with a total score of 50) completed by the trainers based on their observations. Statistical analysis included differences in the knowledge and skills scores before and after the training sessions and between the two periods. Results: A total of 23 healthcare professionals participated and completed both neonatal resuscitation training sessions. The knowledge mean scores before and after the training in 2017 increased from 9.60 to 13.60 (95% CI: -5.900; -2.099, p < 0.001), and in 2018, the scores increased from 10.80 to 15.44 (95% CI: -6.062; -3.217, p < 0.001). The mean knowledge scores post-training over time were 13.60 in 2017 and 15.44 in 2018 (95% CI: -3.489; 0.190, p = 0.030). The resuscitation skills performance between the two time periods increased from a mean of 32.26 (SD = 2.35) to a mean of 42.43 (SD = 1.73) (95% CI: -11.402; -8.945, p < 0.001). Conclusion: The neonatal resuscitation training programme increased the theoretical knowledge and resuscitation skills before and after the two training sessions and over time after a 9-month period. Continuous neonatal resuscitation training based on the local needs in resource-limited countries is essential to provide confidence in healthcare professionals to initiate resuscitation and to improve newborn outcomes.
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Affiliation(s)
- Xiang Ding
- International Affairs, Hunan Children's Hospital, Changsha, China
| | - Li Wang
- International Affairs, Hunan Children's Hospital, Changsha, China
| | | | - Yaojia Hu
- Nursing School, Hunan University of Chinese Medicine, Changsha, China
| | - Jun Qiu
- Editing Office, Journal of Clinical Pediatric Surgery, Hunan Children's Hospital, Changsha, China
| | - Shiying Liu
- International Affairs, Hunan Children's Hospital, Changsha, China
| | - Mi Zhang
- Neonatal Department, Hunan Children's Hospital, Changsha, China
| | - Lihui Zhu
- International Affairs, Hunan Children's Hospital, Changsha, China.,Nursing Department, Hunan Children's Hospital, Changsha, China
| | - Jos M Latour
- International Affairs, Hunan Children's Hospital, Changsha, China.,Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Morris SM, Fratt EM, Rodriguez J, Ruman A, Wibecan L, Nelson BD. Implementation of the Helping Babies Breathe Training Program: A Systematic Review. Pediatrics 2020; 146:peds.2019-3938. [PMID: 32778541 DOI: 10.1542/peds.2019-3938] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Helping Babies Breathe (HBB) is a well-established neonatal resuscitation program designed to reduce newborn mortality in low-resource settings. OBJECTIVES In this literature review, we aim to identify challenges, knowledge gaps, and successes associated with each stage of HBB programming. DATA SOURCES Databases used in the systematic search included Medline, POPLINE, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, African Index Medicus, Cochrane, and Index Medicus. STUDY SELECTION All articles related to HBB, in any language, were included. Article quality was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA EXTRACTION Data were extracted if related to HBB, including its implementation, acquisition and retention of HBB knowledge and skills, changes in provider behavior and clinical care, or the impact on newborn outcomes. RESULTS Ninety-four articles met inclusion criteria. Barriers to HBB implementation include staff turnover and limited time or focus on training and practice. Researchers of several studies found HBB cost-effective. Posttraining decline in knowledge and skills can be prevented with low-dose high-frequency refresher trainings, on-the-job practice, or similar interventions. Impact of HBB training on provider clinical practices varies. Although not universal, researchers in multiple studies have shown a significant association of decreased perinatal mortality with HBB implementation. LIMITATIONS In addition to not conducting a gray literature search, articles relating only to Essential Care for Every Baby or Essential Care for Small Babies were not included in this review. CONCLUSIONS Key challenges and requirements for success associated with each stage of HBB programming were identified. Despite challenges in obtaining neonatal mortality data, the program is widely believed to improve neonatal outcomes in resource-limited settings.
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Affiliation(s)
| | | | | | - Anna Ruman
- Divisions of Global Health and.,Harvard Medical School, Boston, Massachusetts
| | - Leah Wibecan
- Divisions of Global Health and.,Harvard Medical School, Boston, Massachusetts
| | - Brett D Nelson
- Divisions of Global Health and .,Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Wilson GM, Ame AM, Khatib MM, Khalfan BS, Thompson J, Blood-Siegfried J. Helping Babies Breathe (2nd edition) implementation on a shoestring budget in Zanzibar, Tanzania. Matern Health Neonatol Perinatol 2020; 6:3. [PMID: 32518664 PMCID: PMC7268599 DOI: 10.1186/s40748-020-00117-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background To assess the efficacy and viability of implementing Helping Babies Breathe, a neonatal resuscitation program for resource-limited environments on a small budget in two of the largest delivery centers in Zanzibar, Tanzania. The quality improvement initiative concentrated on training midwives, who directly care for neonates at birth on Helping Babies Breathe to address high rates of neonatal mortality secondary to birth asphyxia. Methods The convenience sample was 59 midwives working in the two delivery centers of interest in Zanzibar, Tanzania. The train-the-trainer implementation strategy with repeated measures design was used to assess knowledge and skills at three time points. Observations were completed through supportive supervision of deliveries in both facilities. A budget was kept throughout the implementation. Results Knowledge scores and resuscitation skills significantly improved and were sustained over a 6-month period of time, Ps < .001. 130 supportive supervision observations were completed. Eighteen times (14%) a baby did not cry at birth and needed intervention. All were appropriately intervened for and survived the Golden Minute. The budget for this implementation was 9015.50 USD. Considering in-kind donations and financial support by the Zanzibar Ministry of Health the bottom line cost was much lower. Conclusion Results indicate that participants retained knowledge and skills over time and were able to translate these skills into clinical practice. This initiative provides an alternative approach to implementing Helping Babies Breathe, relying on a small budget, local leadership and government support. Trial registration Not applicable.
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Dol J, Campbell-Yeo M, Bulemela J, McMillan D, Abel Z, Nyamtema A, LeBlanc JC. Knowledge acquisition after Helping Babies Survive training in rural Tanzania. Int Health 2019; 11:136-142. [PMID: 30252052 DOI: 10.1093/inthealth/ihy068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/02/2018] [Accepted: 09/13/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While the effectiveness of Helping Babies Breathe (HBB) training in Tanzania has been reported, no published studies of Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB) in this setting have been found. This study compared knowledge before and after HBB, ECEB and ECSB training in Tanzania. METHODS Training was provided to future facilitators (n=16) and learners (n=24) in Tanzania. Using standardized multiple-choice questions, knowledge was assessed pre- and post-HBB and ECEB courses for both learners and facilitators, while ECSB assessment was conducted with facilitators only. A >80% score was considered to be a pass. Paired t-tests were used for hypothesis testing. RESULTS Knowledge significantly improved for both facilitators and learners on HBB and ECEB (p<0.001) and for facilitators on ECSB (p<0.001). After training, learners had difficulty identifying correct responses on one HBB item (21% incorrect) and three ECEB items (25-29% incorrect). After training, facilitators had difficulty identifying correct responses on five ECSB items (22-44% incorrect). CONCLUSIONS Training improved knowledge in Tanzania, but not sufficiently for feeding, especially for low birthweight babies. Targeted training on feeding is warranted both within the Helping Babies Survive program and in preclinical training to improve knowledge and skill to enhance essential newborn care.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Janeth Bulemela
- Tanzanian Training Center for International Health & St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Douglas McMillan
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, & IWK Health Centre, Halifax, NS, Canada
| | - Zabron Abel
- Tanzanian Training Center for International Health, Ifakara
| | - Angelo Nyamtema
- Tanzanian Training Center for International Health & St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - John C LeBlanc
- Departments of Pediatrics, Community Health and Epidemiology and Psychiatry, Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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