1
|
Diego E, Kamath-Rayne BD, Kukora S, Abayneh M, Rent S. Neonatal Resuscitation and Delivery Room Care: A Changing Global Landscape. Neoreviews 2024; 25:e551-e566. [PMID: 39217135 DOI: 10.1542/neo.25-9-e551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 09/04/2024]
Abstract
With 98% of neonatal deaths occurring in low- and middle-income countries (LMICs), leading health organizations continue to focus on global reduction of neonatal mortality. The presence of a skilled clinician at delivery has been shown to decrease mortality. However, there remain significant barriers to training and maintaining clinician skills and ensuring that facility-specific resources are consistently available to deliver the most essential, evidence-based newborn care. The dynamic nature of resource availability poses an additional challenge for essential newborn care educators in LMICs. With increasing access to advanced neonatal resuscitation interventions (ie, airway devices, code medications, umbilical line placement), the international health-care community is tasked to consider how to best implement these practices safely and effectively in lower-resourced settings. Current educational training programs do not provide specific instructions on how to scale these advanced neonatal resuscitation training components to match available materials, staff proficiency, and system infrastructure. Individual facilities are often faced with adapting content for their local context and capabilities. In this review, we discuss considerations surrounding curriculum adaptation to meet the needs of a rapidly changing landscape of resource availability in LMICs to ensure safety, equity, scalability, and sustainability.
Collapse
Affiliation(s)
- Ellen Diego
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | - Stephanie Kukora
- Division of Neonatology, Center for Bioethics, University of Missouri-Kansas City School of Medicine at Children's Mercy Hospital, Kansas City, MO
| | - Mahlet Abayneh
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharla Rent
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| |
Collapse
|
2
|
Dhungana R, Chalise M, Visick MK, Clark RB. A hybrid approach to skill retention following neonatal resuscitation training: Assessing effectiveness. J Neonatal Perinatal Med 2024; 17:555-564. [PMID: 38788095 DOI: 10.3233/npm-230072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Perinatal death, a global health problem, can be prevented with simple resuscitation interventions that help the baby breathe immediately at birth. Latter-day Saint Charities (LDSC) and Safa Sunaulo Nepal (SSN) implemented a program to scale-up Helping Babies Breathe (HBB) training in Karnali Province, Nepal from January 2020-February 2021. The interventions were implemented using a hybrid approach with on-site mentoring in the pre/post COVID period combined with remote support and monitoring during the COVID period. This paper reports overall changes in newborn outcomes in relation to the unique implementation approach used. A prospective cohort design was used to compare outcomes of birth cohorts in 16 public health facilities in the first and last three months of program implementation. Results showed significant decreases in intrapartum stillbirths (23%), and neonatal deaths within (27%) and after (41.3%) 24 hours of life. The scale-up of HBB training resulted in 557 providers receiving training and mentoring support during the program period, half trained during the COVID period. Increased practice sessions, review meetings and debriefing meetings were reported during the COVID period compared to pre/post COVID period. The evaluation is suggestive of the potential of a hybrid approach for improved perinatal outcomes and scaling-up of newborn resuscitation trainings in health system facing disruptions.
Collapse
Affiliation(s)
| | - M Chalise
- Children's Medical Mission, Kathmandu, Nepal
| | - M K Visick
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - R B Clark
- Brigham Young University, Provo, UT, USA
| |
Collapse
|
3
|
Gifford A, Philemon R, Halbert J, Hothersall EJ, Inglis R, Hart J, Byrne-Davis L, Thirsk J, Gifford H, Howells R, Weetch S, Prentice K, Jackson A, Kirkpatrick M. A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76. MEDICAL TEACHER 2023; 45:685-697. [PMID: 36369858 DOI: 10.1080/0142159x.2022.2137010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Training a skilled healthcare workforce is an essential part in reaching the United Nations Sustainable Development Goal to end preventable deaths in children and neonates. The greatest burden of mortality lies in low and lower-middle income countries (LLMIC). Short term, in-service courses have been implemented in many LLMIC to improve the quality of care delivered, but the evaluation methods of these courses are inconsistent. METHOD Studies describing evaluations of course and outcome measures were included if the course lasted seven days or less with postgraduate participants, included paediatric or neonatal acute or emergency training and was based in a LLMIC. This narrative review provides a detailed description of evaluation methods of course content, delivery and outcome measures based on 'Context, Input, Process and Product' (CIPP) and Kirkpatrick models. RESULTS 5265 titles were screened with 93 articles included after full-text review and quality assessment. Evaluation methods are described: context, input, process, participant satisfaction, change in learning, behaviour, health system infrastructure and patient outcomes. CONCLUSIONS Outcomes, including mortality and morbidity, are rightly considered the fundamental aim of acute-care courses in LLMIC. Course evaluation can be difficult, especially with low resources, but this review outlines what can be done to guide future course organisers in providing well-conducted courses with consistent outcome measures for maximum sustainable impact.
Collapse
Affiliation(s)
| | - Rune Philemon
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jay Halbert
- Department of Paediatrics, University College Hospital, London, England
| | | | - Rebecca Inglis
- Intensive Care Medicine, University of Oxford, Oxford, England
| | - Jo Hart
- Division of Medical Education, University of Manchester, Manchester, England
| | | | - Joanna Thirsk
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | | | - Rachel Howells
- Royal Devon and Exeter NHS Foundation Trust, Exeter, England
| | - Shona Weetch
- Clinical Development, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | | | | | | |
Collapse
|
4
|
Miller L, Wanduru P, Wangia J, Calkins K, Spindler H, Butrick E, Santos N, Kirumbi L, Walker D. Simulation and team training to improve preterm birth knowledge, evidence-based practices, and communication skills in midwives in Kenya and Uganda: Findings from a pre- and post-intervention analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001695. [PMID: 37289721 DOI: 10.1371/journal.pgph.0001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
Simulation training in basic and emergency obstetric and neonatal care has previously shown success in reducing maternal and neonatal mortality in low-resource settings. Though preterm birth is the leading cause of neonatal deaths, application of this training methodology geared specifically towards reducing preterm birth mortality and morbidity has not yet been implemented and evaluated. The East Africa Preterm Birth Initiative (PTBi-EA) was a multi-country cluster randomized controlled (CRCT) trial that successfully improved outcomes of preterm neonates in Migori County, Kenya and the Busoga region of Uganda through an intrapartum package of interventions. PRONTO simulation and team training (STT) was one component of this package and was introduced to maternity unit providers in 13 facilities. This analysis was nested within the larger CRCT and specifically looked at the impact of the STT portion of the intervention package. The PRONTO STT curriculum was modified to emphasize prematurity-related intrapartum and immediate postnatal care practices, such as assessment of gestational age, identification of preterm labour, and administration of antenatal corticosteroids. Knowledge and communication techniques were assessed at the beginning and end of the intervention through a multiple-choice knowledge test. Clinical skills and communication techniques used in context were assessed through the use of evidence-based practiced (EBPs) as documented in video-recorded simulations through StudioCodeTM video analysis. Pre-and-post scores were compared in both categories using Chi-squared tests. Knowledge assessment scores improved from 51% to 73% with maternal-related questions improving from 61% to 74%, neonatal questions from 55% to 73%, and communication technique questions from 31% to 71%. The portion of indicated preterm birth EBPs performed in simulation increased from 55% to 80% with maternal-related EBPs improving from 48% to 73%, neonatal-related EBPs from 63% to 93%, and communication techniques from 52% to 69%. STT substantially increased preterm birth-specific knowledge and EBPs performed in simulation.
Collapse
Affiliation(s)
- Lara Miller
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Phillip Wanduru
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Hilary Spindler
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Elizabeth Butrick
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Nicole Santos
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Leah Kirumbi
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Dilys Walker
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| |
Collapse
|
5
|
Clark RB, Chalise M, Visick MK, Ghosh V, Dhungana R. Scale-Up of a Newborn Resuscitation Capacity-Building and Skill Retention Program Associated With Improved Neonatal Outcomes in Gandaki Province, Nepal. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00046. [PMID: 36853629 PMCID: PMC9972378 DOI: 10.9745/ghsp-d-22-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Intrapartum events leading to asphyxia at birth are a leading cause of neonatal morbidity and mortality in Nepal. In response, the Nepal Ministry of Health and Population adopted the Helping Babies Breathe (HBB) training curriculum in 2015 as a tool to improve neonatal resuscitation and outcomes. Although the effectiveness of HBB training has been well documented, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN) designed an evidence-based intervention for scaling up newborn resuscitation training and skill retention. We report on its implementation and the changes in newborn outcomes during the program period. METHODS The program empowered facility-based trainers in newborn resuscitation and skill retention at 12 facilities in Gandaki Province. Seven of 14 level I hospitals and 5 of 6 level II hospitals were selected. A single external mentor coached the facility-based trainers, provided general support, and monitored progress. Program evaluation tracked changes in newborn metrics over 21 Nepali months (March 2018-November 2019). All deliveries occurring in the health facilities during the program period were included in the evaluation. We assessed program effectiveness by analyzing time trends of neonatal mortality, morbidity, and stillbirths. RESULTS We gathered data on neonatal health outcomes of 33,417 deliveries, including 23,820 vaginal deliveries and 9,597 cesarean deliveries. During the program, 43 facility-based trainers taught resuscitation skills to 425 medical personnel and supported skill retention. Neonatal deaths within 24 hours of birth (incidence rate ratio [IRR]=0.993, P=.044) and newborn morbidities (IRR=0.996, P<.001) showed a significantly declining trend. CONCLUSION Our findings suggest that the SSN program had a substantial influence on critical neonatal outcomes. Future neonatal resuscitation capacity-building and skill retention efforts may benefit from incorporating elements of the program.
Collapse
Affiliation(s)
- Robert B. Clark
- Brigham Young University, Provo, UT, USA.,Correspondence to Robert B. Clark ()
| | | | | | | | | |
Collapse
|
6
|
Bourret K, Mattison C, Hebert E, Kabeya A, Simba S, Crangle M, Darling E, Robinson J. Evidence-informed framework for gender transformative continuing education interventions for midwives and midwifery associations. BMJ Glob Health 2023; 8:bmjgh-2022-011242. [PMID: 36634981 PMCID: PMC9843202 DOI: 10.1136/bmjgh-2022-011242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Continuing education for midwives is an important investment area to improve the quality of sexual and reproductive health services. Interventions must take into account and provide solutions for the systemic barriers and gender inequities faced by midwives. Our objective was to generate concepts and a theoretical framework of the range of factors and gender transformative considerations for the development of continuing education interventions for midwives. METHODS A critical interpretive synthesis complemented by key informant interviews, focus groups, observations and document review was applied. Three electronic bibliographic databases (CINAHL, EMBASE and MEDLINE) were searched from July 2019 to September 2020 and were again updated in June 2021. A coding structure was created to guide the synthesis across the five sources of evidence. RESULTS A total of 4519 records were retrieved through electronic searches and 103 documents were included in the critical interpretive synthesis. Additional evidence totalled 31 key informant interviews, 5 focus groups (Democratic Republic of Congo and Tanzania), 24 programme documents and field observations in the form of notes. The resulting theoretical framework outlines the key considerations including gender, the role of the midwifery association, political and health systems and external forces along with key enabling elements for the design, implementation and evaluation of gender transformative continuing education interventions. CONCLUSION Investments in gender transformative continuing education for midwives, led by midwifery associations, can lead to the improvement of midwifery across all United Nations' target areas including governance, health workforce, health system arrangements and education.
Collapse
Affiliation(s)
- Kirsty Bourret
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden .,McMaster Midwifery Research Center, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cristina Mattison
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emmanuelle Hebert
- Bureau des relations internationales, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Ambrocckha Kabeya
- Société Congolaise de la Pratique Sage-femme, Kinshasa, Democratic Republic of the Congo
| | - Stephano Simba
- Tanzania Midwives Association (TAMA), Dar es Salaam, United Republic of Tanzania
| | - Moya Crangle
- Canadian Association of Midwives, Montreal, Quebec, Canada
| | - Elizabeth Darling
- Obstetrics and Gynecology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jamie Robinson
- Canadian Association of Midwives, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Chan NHM, Merali HS, Mistry N, Kealey R, Campbell DM, Morris SK, Data S. Utilization of a novel mobile application, "HBB Prompt", to reduce Helping Babies Breathe skills decay. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000705. [PMID: 37155596 PMCID: PMC10166562 DOI: 10.1371/journal.pgph.0000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/20/2023] [Indexed: 05/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- Natalie Hoi-Man Chan
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California, United States of America
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hasan S Merali
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Niraj Mistry
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, Toronto, Ontario, Canada
- Design Research, TD Bank Group, Toronto, Ontario, Canada
| | - Douglas M Campbell
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Centre for Global Child Health, and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Uganda
- Consortium for Affordable Medical Technologies in Uganda (CAMTech Uganda), Mbarara, Uganda
| |
Collapse
|
8
|
Shukla VV, Carlo WA, Niermeyer S, Guinsburg R. Neonatal resuscitation from a global perspective. Semin Perinatol 2022; 46:151630. [PMID: 35725655 DOI: 10.1016/j.semperi.2022.151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.
Collapse
Affiliation(s)
- Vivek V Shukla
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Susan Niermeyer
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Ruth Guinsburg
- Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
| |
Collapse
|
9
|
A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2022; 38. [PMID: 36284927 PMCID: PMC9549591 DOI: 10.7196/sajcc.2022.v38i2.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
Background
Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child
mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In
recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted
in December 2019 at the University Hospital Mahajanga.
Objectives
This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved
their learning objectives.
Methods
In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their
learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were
conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities.
Results
Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs
and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multi-disciplinary efforts are needed to advance ETAT+ implementation in Madagascar.
Conclusion
Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of
care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to
contexts in Madagascar.
Contributions of the study
This study aims to evaluate an updated Malagasy version of the Emergency Triage Assessment and Treatment Plus (ETAT+). The training met the
participants’ needs and was adapted to the clinical realities in Madagascar relating to transmitted knowledge, skills and competencies.
Collapse
|
10
|
Mbinda MA, Moshi FV. Identifying factors associated with neonatal resuscitation skills among nurses and midwives in Tanzania, sub-Saharan Africa. SAGE Open Med 2022; 10:20503121221100991. [PMID: 35646357 PMCID: PMC9136440 DOI: 10.1177/20503121221100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The objective of this study was to identify factors associated with nurses' and midwives' skills in performing neonatal resuscitation. Method Health facility-based analytical cross-sectional study design was employed from January 2021 to April 2021 among 340 nurses and midwives selected by multistage random sampling technique. An observation checklist was used to collect data. Data were coded and entered into SPSS version 20 for analysis. Bivariate and multivariate logistic regression was used to assess factors associated with nurse/midwives' skills in neonatal resuscitation. Results Among 340 nurses and midwives, 141 (41%) had adequate skills in neonatal resuscitation. After adjusting for confounders, factors associated with adequate skills were; age of the midwives (20-34 (adjusted odds ratio = 0.082, p < 0.008) and 35-49 (adjusted odds ratio = 0.087, p < 0.010)); work experience (worked 4-6 (adjusted odds ratio = 2.905, p < 0.003) and > 10 years and above (adjusted odds ratio = 12.825, p < 0.000)); district hospitals (adjusted odds ratio = 1.544, p = 0.032); distance from place of residence (6-10 km (adjusted odds ratio = 0.090, p < 0.001) and > 16 km (adjusted odds ratio = 0.049, p < 0.001)); number of midwives per shift, ⩾ 4 (adjusted odds ratio = 2.396, p = 0.012) and number of deliveries per day (6-10 (adjusted odds ratio = 1.385, p < 0.031), 11-20 (adjusted odds ratio = 2.693, p < 0.016) and > 20 delivery per day (adjusted odds ratio = 6.007, p < 0.001). Conclusion Less than half of the observed nurses and midwives had adequate skills in neonatal resuscitation. Nurses and midwives who were younger, less experienced (<4 years of work experience), and work in small, lower volume settings with fewer colleagues and limited births (dispensaries, fewer than four nurses and midwives per shift, less than six deliveries per day) were less likely to have adequate skills in neonatal resuscitation. Knowledge gained from this study may provide future research related to a cost-effective strategy to empower nurses and midwives in neonatal resuscitation.
Collapse
Affiliation(s)
- Mathias Anthony Mbinda
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Fabiola Vincent Moshi
- Department of Nursing Management and Education, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| |
Collapse
|
11
|
Implementation of low-fidelity simulation education to improve knowledge and self-efficacy for nurses caring for Post-genital affirming surgical patients. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
12
|
Patel S, Carter G, Minton D, Hunsberger JB, Koka R, Collins R, Shoemaker L, Toy S, Kudchadkar SR. Feasibility, implementation, and outcomes of in situ simulation-based curriculum to manage common emergencies in the pediatric post-anesthesia care unit. J Pediatr Nurs 2022; 64:84-90. [PMID: 35245814 DOI: 10.1016/j.pedn.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Studies have shown that most critical events that occur in the post-anesthesia care unit (PACU), including cardiac arrests, are preventable and respiratory in origin. Admission to the PACU necessitates transfer of care from anesthesiology staff to PACU nurses. The aim of the study is to assess a) feasibility in implementing an in-situ curriculum for PACU nurses to manage common pediatric emergencies, b) the effectiveness of the curriculum in improving self-confidence of the PACU nurses in performing essential skills c) nurses'' perception of such an offering. DESIGN AND METHODS This was a single center curricular evaluation study. Anonymous surveys were used to assess curriculum effectiveness by comparing self-reported confidence in the execution of key technical skills and application of knowledge in a real clinical environment at three time points: baseline, immediately post-simulation, and 3 months later. RESULTS Of 50 PACU nurses, 80%, 98% and 58% responded to the targeted needs assessment, post-simulation and follow up (at 3 months) survey respectively. Self-reported confidence levels for most of the essential skills were significantly increased immediately after simulation and at 3 months. Most of the participants responded that the simulation training helped them improve care of hypoxic (83%) and hypotensive (62%) patients in the PACU. CONCLUSION Implementation of in situ curriculum for PACU nurses was feasible. The self-reported confidence in performing essential skills increased significantly and the nurses could apply these skills in real clinical environment. PRACTICE IMPLICATIONS Interprofessional simulation should be implemented in all high risk units to optimize safety of children.
Collapse
Affiliation(s)
- Shivani Patel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Grace Carter
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, United States of America
| | - Dawn Minton
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, United States of America
| | - Joann B Hunsberger
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Rahul Koka
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Richard Collins
- Johns Hopkins Simulation Center, Baltimore, MD, United States of America
| | - Lisa Shoemaker
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, United States of America
| | - Serkan Toy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| |
Collapse
|
13
|
Prasad N, Mwakatundu N, Dominico S, Masako P, Mongo W, Mwanshemele Y, Maro G, Subi L, Chaote P, Rusibamayila N, Ruiz A, Schmidt K, Kasanga MG, Lobis S, Serbanescu F. Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00484. [PMID: 35487559 PMCID: PMC9053157 DOI: 10.9745/ghsp-d-21-00484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
Abstract
The 13-year Program to Reduce Maternal Deaths in Tanzania employed multifaceted maternal, newborn, and reproductive health interventions that contributed to increasing the availability and utilization of high-quality obstetric and family planning services and reducing maternal and perinatal mortality in Kigoma. The Program to Reduce Maternal Deaths in Tanzania was a 13-year (2006–2019) effort in the Kigoma region that evolved over 3 phases to improve and sustain the availability of, access to, and demand for high-quality maternal and reproductive health care services. The Program intended to bring high-quality care closer to more communities. Cutting across the Program was the routine collection of monitoring and evaluation data. The Program achieved significant reductions in maternal and perinatal mortality, a significant increase in the modern contraceptive prevalence rate, and a significant decline in the unmet need for contraception. By 2017, it was apparent that the Program was on track to meet or surpass many of the targets established by the Government of Tanzania. Over the following 2-plus years, efforts to sustain Program interventions intensified. In April 2019, the Program fully transitioned to Government of Tanzania oversight. Four key lessons were learned during implementation that are relevant to governments, donors, and implementing organizations working to reduce maternal mortality: (1) multistakeholder partnerships are critical; (2) demand creation for services, while critical, must rest on a foundation of well-functioning and high-quality clinical services; (3) it is imperative to not only collect robust monitoring and evaluation data, but to be responsive in real time to what the data reveal; and, (4) it is necessary to develop a deliberate sustainability strategy from the start. The Program in Kigoma demonstrates that decentralizing high-quality maternal and reproductive health services in remote, low-resource settings is both feasible and effective and should be considered in places with similar contexts. By embedding the Program in the existing health system, and through efforts to build local capacity, the improvements seen in Kigoma are likely to be sustained. Follow-up evaluations are planned, providing an opportunity to more directly assess sustainability.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Paul Chaote
- President's Office Regional Administration and Local Government, Health Social Welfare and Nutrition Division, Dodoma, Tanzania
| | - Neema Rusibamayila
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Alicia Ruiz
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | | | | | | | - Florina Serbanescu
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA.
| |
Collapse
|
14
|
Munyaw Y, Gidabayda J, Yeconia A, Guga G, Mduma E, Mdoe P. Beyond research: improved perinatal care through scale-up of a Moyo fetal heart rate monitor coupled with simulation training in northern Tanzania for helping babies breathe. BMC Pediatr 2022; 22:191. [PMID: 35410324 PMCID: PMC8996520 DOI: 10.1186/s12887-022-03249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this project was to improve perinatal survival by introducing Moyo Fetal Heart Rate (FHR) Monitor coupled with neonatal resuscitation simulation training. METHODS The implementation was done at three district hospitals. We assessed health care workers' (HCW's) skills and perinatal death trends during implementation. Baseline data were collected from the hospitals before implementation. Newborn resuscitation (NR) skills were assessed before and after simulation training. Assessment of perinatal outcomes was done over 2 years of implementation. We used descriptive analysis; a t-test (paired and independent two-sample) and a one-way Anova test to report the findings. RESULTS A total of 107 HCW's were trained on FHR monitoring using Moyo and NR knowledge and skills using NeoNatalie simulators. The knowledge increased post-training by 13.6% (p < 0.001). Skills score was increased by 25.5 and 38.2% for OSCE A and B respectively (p < 0.001). The overall fresh stillbirths rate dropped from 9 to 5 deaths per 1000 total births and early neonatal deaths at 7 days from 5 to 3 (p < 0.05) deaths per 1000 live births over 2 years of implementation. CONCLUSION There was a significant improvement of newborn resuscitation skills among HCW's and neonatal survival at 2 years. Newborn resuscitation training coupling with Moyo FHR monitor has shown potential for improving perinatal survival. However, further evaluation is needed to explore the full potential of the package.
Collapse
Affiliation(s)
- Yuda Munyaw
- Department of Obstetrics and Gynecology, Haydom Lutheran Hospital, P.O BOX 9000, Haydom, Mbulu, Tanzania.
| | - Joshua Gidabayda
- Department of Pediatrics, Haydom Lutheran Hospital, P.O BOX 9000, Haydom, Mbulu, Tanzania
| | - Anita Yeconia
- Research Centre, Haydom Lutheran Hospital, P.O BOX 9000, Haydom, Mbulu, Tanzania
| | - Godfrey Guga
- Research Centre, Haydom Lutheran Hospital, P.O BOX 9000, Haydom, Mbulu, Tanzania
| | - Esto Mduma
- Research Centre, Haydom Lutheran Hospital, P.O BOX 9000, Haydom, Mbulu, Tanzania
| | - Paschal Mdoe
- Research Centre, Haydom Lutheran Hospital, P.O BOX 9000, Haydom, Mbulu, Tanzania
| |
Collapse
|
15
|
Merali HS, Hemed M, Fernando AM, Rizwan S, Mangala EL, Wood AM, Abdalla K, Patterson J, Amick E, Foehringer Merchant H, Smith SL, Wheatley RR, Kamath-Rayne BD. Telementoring initiative for newborn care providers in Kenya, Pakistan and Tanzania. Trop Med Int Health 2022; 27:426-437. [PMID: 35239251 DOI: 10.1111/tmi.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To support governments' efforts at neonatal mortality reduction, UNICEF and the American Academy of Pediatrics launched a telementoring project in Kenya, Pakistan and Tanzania. METHODS In Fall 2019, an individualised 12-session telementoring curriculum was created for East Africa and Pakistan after site visits that included care assessment, patient data review and discussion with faculty and staff. After the programme, participants, administrators and UNICEF staff were surveyed and participated in focus group discussions. RESULTS Participants felt the programme improved knowledge and newborn care. Qualitative analysis found three common themes of successful telementoring: local buy-in, use of existing training or clinical improvement structures, and consideration of technology needs. CONCLUSIONS Telementoring has potential as a powerful tool in newborn education. It offers more flexibility and easier access than in-person sessions. This project has the potential for scale-up, particularly when physical distancing and travel restrictions are the norm.
Collapse
Affiliation(s)
- Hasan S Merali
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | | | | | | | | | - Amy M Wood
- Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
| | | | | | - Erick Amick
- American Academy of Pediatrics, Itasca, IL, USA
| | | | | | | | | |
Collapse
|
16
|
Chalise M, Dhungana R, Visick MK, Clark RB. Assessing the effectiveness of newborn resuscitation training and skill retention program on neonatal outcomes in Madhesh Province, Nepal. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000666. [PMID: 36962548 PMCID: PMC10022377 DOI: 10.1371/journal.pgph.0000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/19/2022] [Indexed: 03/26/2023]
Abstract
Intrapartum events leading to asphyxia at birth are among 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 competencies. The effectiveness of HBB trainings has been well established. However, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN), with support from Latter-day Saint Charities (LDS Charities) designed an initiative for scaling up newborn resuscitation training and skills maintenance over time. This paper reports on the implementation of the SSN model of newborn resuscitation trainings and skill retention, and the changes in perinatal outcomes that occurred after the program. The program built capacity among facility-based trainers for the scale up and maintenance of 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. Data was gathered on the neonatal health outcomes of 68,435 vaginal deliveries and 9,253 cesarean sections. Results indicate decreases in neonatal deaths under 24 hours of life (p<0.001), intrapartum stillbirths (p<0.001), and the 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 ongoing skill retention. The SSN model for newborn resuscitation training and skills retention 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.
Collapse
Affiliation(s)
- Mala Chalise
- Children's Medical Mission, Payson, Utah, United States of America
| | | | - Michael K Visick
- University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Robert B Clark
- Brigham Young University, Provo, UT, United States of America
| |
Collapse
|
17
|
Kamath AM, Thom MG, Johanns CK, Panhorst Harris K, Schwarzbauer K, Ochoa JC, Zuniga-Brenes P, Rios-Zertuche D, Mokdad AH, Hernandez B. Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica. BMC Pediatr 2021; 21:534. [PMID: 34852795 PMCID: PMC8638427 DOI: 10.1186/s12887-021-02999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region. METHODS A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011-2013) and at second-phase follow-up (2017-2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression. RESULTS Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3-4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4-12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%). CONCLUSION SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.
Collapse
Affiliation(s)
- Aruna M Kamath
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA. .,Department of Anesthesiology, University of Washington, Seattle, WA, USA.
| | - Maximilian G Thom
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Katie Panhorst Harris
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | | | - José C Ochoa
- Inter-American Development Bank, Washington, DC, USA
| | | | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| |
Collapse
|
18
|
Jourabian A, Jafari-Mianaei S, Ajoodanian ND. Evaluating the implementation of helping babies survive program to improve newborn care conditiona. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:373. [PMID: 34912909 PMCID: PMC8641757 DOI: 10.4103/jehp.jehp_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The main reason of newborn mortalities in low- and middle-income countries is due to the lack of skilled caregivers in providing essential care for babies. The aim of the present study was to evaluate the implementation of helping babies survive (HBS) program to improve newborn care condition in Isfahan, Iran. MATERIALS AND METHODS This quasi-experimental study was conducted in the labor and midwifery wards of Shahid Beheshti Hospital in Isfahan. Convenience sampling method was used for all healthy newborns who weighed >1500 g. First, the samples were selected for the control group. Then, the Helping Babies Breathe and Essential Care for Every Baby training courses were held over for ward nurses and midwives. Then, the samples of the intervention group were selected. The research tools consisted of demographic characteristic questionnaire, caregiver performance evaluation checklist, and breastfeeding registration checklist. SPSS software version 16 was used for data analysis. RESULTS A total of 130 newborns were divided into control (n = 65) and intervention groups (n = 65). The average time of umbilical cord clamping increased from 13.85 to 61.48 s, and the average duration of skin-to-skin contact between mother and baby increased from 11.75 to 60.47 min. The mean of early initiation of breastfeeding improved during the 1st h and the 1st day of the birth. The rate of neonatal hypothermia in the intervention group decreased sharply. CONCLUSION The implementation of the HBS program can positively impact newborn care condition.
Collapse
Affiliation(s)
- Atefeh Jourabian
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soheila Jafari-Mianaei
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Najmeh D Ajoodanian
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
19
|
Liaqat M, Hussain M, Afzal M, Altaf M, Khan S, Gilani SA, Liaqat I. Efficacy of pedagogical framework in neonatal resuscitation skill learning in a resource-limited setting: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:436. [PMID: 34407810 PMCID: PMC8371841 DOI: 10.1186/s12909-021-02846-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The educational efficacy in neonatal resuscitation relies on the subject and teaching strategies. Therefore, it is imperative to test diverse educational methods if they are more instructive to engage students in active learning and practicing knowledge. Hence, the present study aims to investigate the efficacy of a pedagogical framework in neonatal resuscitation skill learning among nursing students in a resource-limited setting. METHODS A single-blind randomized controlled trial was conducted between October 2020 to March 2021. Sixty nursing students in the 3rd and 4th year of professional training were randomly allocated to the pedagogy and the traditional group. The pedagogy group learned via 6-step LSPPDM (Learn, See, Practice, Prove, Do, Maintain) pedagogy including lectures, video, clinical observation, skill sessions under supervision, and self-directed practice. The traditional group learned through 2-step (Learn, Practice) method that included lectures and skill sessions under supervision. The outcomes measured included technical and non-technical skills in neonatal resuscitation. The technical skill deals with steps such as stimulation, ventilation, oxygenation, intubation, chest compression, medications, and reporting. Non-technical skills refer to teamwork skills that focus on the interaction between leader and helper. Both skills were measured through previously published validated tools two times before and after the intervention by blinded assessors in a simulated delivery room. RESULTS Overall, the skill was significantly improved in both groups after intervention. Yet, the results showed that the mean difference of technical skill score in the pedagogy group (24.3 ± 3.5) was significantly higher (p < 0.001) compared to the traditional group (16.2 ± 2.4). Likewise, the mean difference of non-technical skill score in the pedagogy (36.9 ± 1.9) was highly significant (p < 0.001) compared to the traditional group (31.2 ± 1.7). CONCLUSIONS The LSPPDM pedagogy was found more effective in enhancing technical and non-technical skills in neonatal resuscitation compared to the traditional method. The results of this study support the efficacy of the 6-step LSPPDM pedagogy in the education of nursing students regarding neonatal resuscitation in a resource-limited setting. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov ( NCT04748341 ).
Collapse
Affiliation(s)
- Mishal Liaqat
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan.
| | - Muhammad Hussain
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Muhammad Afzal
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Maryam Altaf
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Sadia Khan
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Iram Liaqat
- Department of Zoology, The Government College University, Lahore, Pakistan
| |
Collapse
|
20
|
Dinur G, Borenstein-Levin L, Vider S, Hochwald O, Jubran H, Littner Y, Fleischer-Sheffer V, Kugelman A. Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study. J Perinat Med 2021; 49:520-525. [PMID: 33470963 DOI: 10.1515/jpm-2020-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation. METHODS A prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped. RESULTS Audio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to "positive pressure ventilation" (p<0.01). CONCLUSIONS In this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.
Collapse
Affiliation(s)
- Gil Dinur
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Shachar Vider
- Department of Orthopedic Surgery, Technion - Israel Institute of Technology, Rambam Health Care Campus, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoav Littner
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Vered Fleischer-Sheffer
- Department of Neonatology, Galilee Medical Center, Naharia,Israel.,Bar-Ilan University, Azrieli Faculty of Medicine, Safed, Israel
| | - Amir Kugelman
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Bucher SL, Cardellichio P, Muinga N, Patterson JK, Thukral A, Deorari AK, Data S, Umoren R, Purkayastha S. Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs. Pediatrics 2020; 146:S165-S182. [PMID: 33004639 DOI: 10.1542/peds.2020-016915i] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.
Collapse
Affiliation(s)
- Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; .,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | | | - Naomi Muinga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, School of Medicine, Seattle, Washington.,Department of Global Health, School of Medicine, University of Washington, Seattle, Washington; and
| | - Saptarshi Purkayastha
- Department of Data Science and Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| |
Collapse
|
23
|
Perlman JM, Velaphi S, Massawe A, Clarke R, Merali HS, Ersdal H. Achieving Country-Wide Scale for Helping Babies Breathe and Helping Babies Survive. Pediatrics 2020; 146:S194-S207. [PMID: 33004641 DOI: 10.1542/peds.2020-016915k] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Helping Babies Breathe (HBB) was piloted in 2009 as a program targeted to reduce neonatal mortality (NM). The program has morphed into a suite of programs termed Helping Babies Survive that includes Essential Care for Every Baby. Since 2010, the HBB and Helping Babies Survive training programs have been taught to >850 000 providers in 80 countries. Initial HBB training is associated with a significant improvement in knowledge and skills. However, at refresher training, there is a knowledge-skill gap evident, with a falloff in skills. Accumulating evidence supports the role for frequent refresher resuscitation training in facilitating skills retention. Beyond skill acquisition, HBB has been associated with a significant reduction in early NM (<24 hours) and fresh stillbirth rates. To evaluate the large-scale impact of the growth of skilled birth attendants, we analyzed NM rates in sub-Saharan Africa (n = 11) and Nepal (as areas of growing HBB implementation). All have revealed a consistent reduction in NM at 28 days between 2009 and 2018; a mean reduction of 5.34%. The number of skilled birth attendants, an indirect measure of HBB sustained rollout, reveals significant correlation with NM, fresh stillbirth, and perinatal mortality rates, highlighting HBB's success and the need for continued efforts to train frontline providers. A novel live newborn resuscitation trainer as well as a novel app (HBB Prompt) have been developed, increasing knowledge and skills while providing simulation-based repeated practice. Ongoing challenges in sustaining resources (financial and other) for newborn programming emphasize the need for innovative implementation strategies and training tools.
Collapse
Affiliation(s)
- Jeffrey M Perlman
- Weill Cornell Medicine and New York-Presbyterian Komansky Children's Hospital, New York, New York;
| | - Sithembiso Velaphi
- Department of Pediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Augustine Massawe
- Department of Pediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Robert Clarke
- Maternal and Newborn Care, Latter-day Saint Charities Affiliate Faculty and Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah
| | - Hasan S Merali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada; and
| | - Hege Ersdal
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Chinbuah MA, Taylor M, Serpa M, Mazia G, Cofie PK, Kwarah W, Dawson S, Nelson BD, Engmann C. Scaling up Ghana's national newborn care initiative: integrating 'helping babies breathe' (HBB), 'essential care for every baby' (ECEB), and newborn 'infection prevention' (IP) trainings. BMC Health Serv Res 2020; 20:739. [PMID: 32787838 PMCID: PMC7422609 DOI: 10.1186/s12913-020-05225-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Responding to stagnating neonatal mortality rates in Ghana, a five-year collaboration called Making Every Baby Count Initiative (MEBCI) was undertaken to improve the quality of newborn care provided around the time of birth. A multi-pronged approach was used to build health worker (HW) capacity in resuscitation, essential newborn care, and infection prevention using a curriculum built on the American Academy of Pediatric’s (AAP) Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) modules with an added section on infection prevention (IP). Methods MEBCI used a training of trainer’s approach to train 3688 health workers from district-level facilities in four regions in Ghana between June 2015 and July 2017. Prior to training, HWs familiarized themselves with the learning materials. Concurrently, MEBCI worked to improve enabling environments that would sustain the increased capacity of trained health workers. Knowledge and skills gained were tested using AAP’s Knowledge checklist and validated single-scenario Objective Structured Clinical Examinations (OSCEs) tools. Findings: Majority of HWs trained were midwives (58.8%) and came from district-level hospitals (88.4%). Most HWs passed the HBB OSCE (99.9%, 3436/3440). Age of doctors was negatively associated with HBB scores (r = − 0.16, p = 0.0312). Similarly, older midwives had lower HBB scores (r = − 0.33, p value < 0.001). Initiating ventilation within the Golden Minute was challenging for HWs (78.5% passed) across all regions. Overall, the pass rate for ECEB OSCEs was 99.9% in all regions. Classify newborn for further care and communicate plan to family were frequent challenges observed in Volta Region (69.5% and 72.0% pass rate respectively). HWs less than 40 years of age performed significantly better than health workers older than 40 years (p = 0.023). Age of only paediatricians was positively associated with ECEB scores (r = 0.77, p < 0.001) while age of midwives was negatively associated with ECEB scores (r = − 0.08, p < 0.001). Conclusion MEBCI’s integrated HBB-ECEB-IP training resulted in significant mastery of the clinical knowledge and skills of HWs. Harmonization and standardization of the course delivery by trainers and having a core team to ensure training fidelity are essential to maintaining high quality while scaling a program nationally. Funding Children’s Investment Fund Foundation (CIFF).
Collapse
Affiliation(s)
| | - Mira Taylor
- PATH, Accra, Ghana.,Koforidua Regional Hospital, Eastern Region, Ghana Health Services, Koforidua, Ghana
| | - Magdalena Serpa
- PATH, DC, Seattle, USA.,One Health Institute, Colorado State University, Colorado, CO, USA
| | - Goldy Mazia
- PATH, DC, Seattle, USA.,Save the Children, Westport, USA
| | | | | | | | - Brett D Nelson
- Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cyril Engmann
- PATH, DC, Seattle, USA.,Departments of Pediatrics and Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA
| |
Collapse
|
26
|
Sintayehu Y, Desalew A, Geda B, Tiruye G, Mezmur H, Shiferaw K, Mulatu T. Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained: An observational study. PLoS One 2020; 15:e0236194. [PMID: 32706775 PMCID: PMC7380629 DOI: 10.1371/journal.pone.0236194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neonatal resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Worldwide, four million neonate deaths happen annually, and birth asphyxia accounts for one million deaths. Improving providers' neonatal resuscitation skills is critical for delivering quality care and for morbidity and mortality reduction. However, retention of these skills has been challenging in developing countries, including Ethiopia. Hence, this study aimed to assess neonatal resuscitation skills retention and associated factors among midwives and nurses in Eastern Ethiopia. METHODS An institution-based cross-sectional study was conducted using a pre-tested, structured, observational checklist. A total of 427 midwives and nurses were included from 28 public health facilities by cluster sampling and simple random sampling methods. Data were collected on facility type, availability of essential resuscitation equipment, socio-demographic characteristics of participants, current working unit, years of professional experience, whether a nurse or midwife received refresher training, and skills and knowledge related to neonatal resuscitation. Binary logistic regression was used to analyse the association between neonatal resuscitation skill retention and independent variables. RESULTS About 11.2% of nurses and midwives were found to have retention of neonatal resuscitation skills. Being a midwife (AOR, 7.39 [95% CI: 2.25, 24.24]), ever performing neonatal resuscitation (AOR, 3.33 [95% CI: 1.09, 10.15]), bachelor sciences degree or above (AOR, 4.21 [95% CI: 1.60, 11.00]), and good knowledge of neonatal resuscitation (AOR, 3.31 [95% CI: 1.41, 7.73]) were significantly associated with skill retention of midwives and nurses. CONCLUSION Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained. This could increase the death of neonates due to asphyxia. Being a midwife, Bachelor Sciences degree or above educational status, ever performing neonatal resuscitation, and good knowledge were associated with skill retention. Providers should be encouraged to upgrade their educational level to build their skill retention and expose themselves to NR. Further, understanding factors affecting how midwives and nurses gain and retain skills using high-level methodology are essential.
Collapse
Affiliation(s)
- Yitagesu Sintayehu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Assefa Desalew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haymanot Mezmur
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
27
|
Higham H. Simulation past, present and future—a decade of progress in simulation-based education in the UK. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:404-409. [DOI: 10.1136/bmjstel-2020-000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Abstract
This review will present developments in simulation-based education (SBE) over the past decade with a focus on activity in the UK’s National Health Service and the role of the national society (the Association for Simulation Practice in Healthcare). The article covers the evolution of strategic changes for the use of SBE in the UK and the operational challenges faced by clinicians and other faculty in SBE. The expansion of the evidence base to support SBE in healthcare both in technical skills and, more broadly, in interprofessional team training is explored. Finally, the wider role of simulation in patient safety and healthcare systems, including testing pathways and the development of cognitive aids and involvement of patients in SBE is considered.
Collapse
|
28
|
Scale-Up of Doppler to Improve Intrapartum Fetal Heart Rate Monitoring in Tanzania: A Qualitative Assessment of National and Regional/District Level Implementation Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061931. [PMID: 32188037 PMCID: PMC7142453 DOI: 10.3390/ijerph17061931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 12/18/2022]
Abstract
High-quality intrapartum care, including intermittent monitoring of fetal heart rates (FHR) to detect and manage abnormalities, is recommended by WHO and the Government of Tanzania (GoT) and creates potential to save newborn lives in Tanzania. Handheld Doppler devices have been investigated in several low-resource countries as an alternative to Pinard stethoscope and are more sensitive to detecting accelerations and decelerations of the fetal heart as compared to Pinard. This study assessed perspectives of high-level Tanzanian policymakers on facilitators and barriers to scaling up use of the hand-held Doppler for assessing FHR during labor and delivery. From November 2018-August 2019, nine high-level policymakers and subject matter experts were interviewed using a semi-structured questionnaire, with theoretical domains drawn from Proctor's implementation outcomes framework. Interviewees largely saw use of Doppler to improve intrapartum FHR monitoring as aligning with national priorities, though they noted competing demands for resources. They felt that GoT should fund Doppler, but prioritization and budgeting should be driven from district level. Recommended ways forward included learning from scale up of Helping Babies Breathe rollout, making training approaches effective, using clinical mentoring, and establishing systematic monitoring of outcomes. To be most effective, introduction of Doppler must be concurrent with improving case management practices for abnormal intrapartum FHR. WHO's guidance on scale-up, as well as implementation science frameworks, should be considered to guide implementation and evaluation.
Collapse
|
29
|
Shukla V, Mwenechanya M, Carlo WA. Dealing with neonatal emergencies in low-resource settings. Semin Fetal Neonatal Med 2019; 24:101028. [PMID: 31744767 DOI: 10.1016/j.siny.2019.101028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe the development and delivery of neonatal care including trends and impacts of major interventions on neonatal mortality particularly in low-resource settings. Low- and middle-income countries continue to be major contributors to neonatal mortality. Although there has been progress in reducing neonatal mortality, neonatal deaths are contributing an increasing percentage of childhood mortality. Several interventions targeting neonatal care such as neonatal resuscitation and essential newborn care have contributed to improved outcomes. However, there are still many neonatal deaths that are preventable with known effective interventions. This review addresses interventions proven effective in reducing neonatal mortality, challenges to implement them, and future directions of implementing these interventions in low- and middle-income countries.
Collapse
Affiliation(s)
- Vivek Shukla
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA
| | - Musaku Mwenechanya
- University Teaching Hospital- Children's Hospital, Nationalist Road, Lusaka, Zambia
| | - Waldemar A Carlo
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA.
| |
Collapse
|
30
|
Groothuis E, Van Genderen K. Helping Babies Breathe: Improving Neonatal Resuscitation and Global Neonatal Mortality. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|