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Graef SE, Karimi N, Xu M, Petropoulos JA, Ngo QN, Bilgic E. What is the impact of simulation-based training for paediatric procedures on patient outcomes, cost and latent safety threats? CLINICAL TEACHER 2024:e13786. [PMID: 38812076 DOI: 10.1111/tct.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Simulation-based training (SBT) provides a safe space for medical trainees to experience realistic scenarios. SBT has been found to improve trainee performance in paediatric procedures. However, limited evidence exists regarding its effects on higher-level outcomes. This scoping review aims to identify studies that investigate the impact of SBT for procedural skills on T3 (patient outcomes) and T4 level outcomes (latent safety threats [LSTs], and hospital level costs) in paediatrics. METHODS Full-text articles were included if they focused on medical trainees, used simulation training for paediatric procedures and reported T3/T4 level outcomes. Six databases were searched from January 2011 to September 2022. Search strategies were developed with the assistance of a librarian. Three independent reviewers performed pilot screenings before title/abstract and full-text screenings. A data extraction sheet was created to gather information on interventions, outcomes, research design, and other study characteristics. FINDINGS After title/abstract screening of 4,076 sources, 50 were included for full-text review, with 15 articles selected for data extraction. Four were randomised control studies (RCTs), fourteen focused on T3 level outcomes including mortality rates, and one measured LSTs. There were no studies reporting cost-related data. Three of the studies focused on bag-and-mask ventilation, and eight mentioned the use of mannequins. DISCUSSION We highlight the potential effectiveness of simulation-based training of paediatric procedural skills in improving patient outcomes, such as reduced mortality rates and incidence of illness/injury. CONCLUSION Though the quality of research designs was low, researchers used different simulation modalities and outcome measures and showed a positive impact of SBT(e.g., decreased mortality rates).
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Affiliation(s)
- Samuel E Graef
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nima Karimi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maggie Xu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Quang N Ngo
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elif Bilgic
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Education Research, Innovation and Theory (MERIT) Program, Hamilton, Ontario, Canada
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Lee HY, Cooper JE, Kruk ME. Regional determinants of quality of care for sick children: A multilevel analysis in four countries. J Glob Health 2024; 14:04053. [PMID: 38483441 PMCID: PMC10939116 DOI: 10.7189/jogh.14.04053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background The limited impact of increased access to care on improvements in health outcomes during the Millennium Development Goal era has been attributed, in part, to inadequate quality of care. We identified regional factors associated with health service quality for sick child care in low-income countries and examined whether provider factors interact with regional factors to affect the quality of care. Methods We conducted cross-sectional random intercept four-level linear regression using the most recent Service Provision Assessment and Demographic Health Survey data from four countries (467 from the Democratic Republic of Congo 2018, 2425 from Afghanistan 2018, 2072 from Nepal 2015, and 813 from Senegal 2017). The outcome variable was the service quality score for sick child care, which was measured as the percentage of clinically recommended tasks completed in the integrated management of childhood illness (ranging from 0 to 100). Regional factors were selected based on the High-Quality Health System Framework. Results The service quality score was found to be positively associated with the proportion of large facilities (β = 8.61; P = 0.004) and the proportion of providers ranked in the top fifth for service quality score (β = 30.15; P < 0.001) in the region. We identified significant cross-level interactions between provider qualifications (β = -16.6; P < 0.001) or job descriptions (β = 12.01; P = 0.002) and the proportion of providers in the top fifth for service quality scores within the region. As the proportion of top-performing providers in a region increased, the increase in the service quality score was more pronounced among providers who were nonmedical doctors or did not have job descriptions than among their counterparts. Conclusions Our findings indicate that the quality of care for sick children in a region improves with a greater proportion of high-performing providers or larger facilities. Providers who are not medical doctors, or those who have specific job descriptions, tend to benefit more from the presence of these top-performing providers.
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Affiliation(s)
- Hwa-Young Lee
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jan E Cooper
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Kikaya V, Katembwe F, Yabili J, Mbwanya M, Dhuse E, Gomez P, Waxman R, Mohan D, Tappis H. Effectiveness of Capacity-Building and Quality Improvement Interventions to Improve Day-of-Birth Care in Kinshasa, Democratic Republic of the Congo. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:GHSP-D-23-00236. [PMID: 38365280 PMCID: PMC10906559 DOI: 10.9745/ghsp-d-23-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
In sub-Saharan African settings like the Democratic Republic of the Congo, high-quality care during childbirth and the immediate postpartum period is lacking in public facilities, necessitating multipronged interventions to improve care. We used a pre-post design to examine the effectiveness of a low-dose, high-frequency capacity-building and quality improvement (QI) intervention to improve care for women and newborns around the day of birth in 16 health facilities in Kinshasa, Democratic Republic of the Congo. Effectiveness was assessed based on changes in provider skills, key health indicators, and beneficiary satisfaction. To assess changes in the competency of the 188 providers participating in the intervention, we conducted objective structured clinical examinations on care for mothers and newborns on the day of birth, immediate postpartum family planning (PPFP) counseling and method provision, and postabortion care before and after implementation of training and at 6 and 12 months after training. Interrupted time series (ITS) analysis techniques were used to analyze routine health service data for changes in select maternal, newborn, and postpartum outcomes before and after the intervention. To assess changes in clients' perceptions of care, 2 rounds of telephone surveys were administered. Before the intervention, less than 2% of participating providers demonstrated competency in skills. Immediately after training, more than 80% demonstrated competency, and 70% retained competency after 12 months. ITS analyses show the risk of early neonatal death declined significantly by 9% (95% confidence interval [CI]=4%, 13%, P<.001), and likelihood of immediate PPFP uptake increased significantly by 72% (95% CI=53%, 92%, P<.001). Client satisfaction improved by 58% over the life of the project. These findings build on previous studies documenting the effectiveness of clinical capacity-building and QI approaches. If implemented at scale, this approach has the potential to substantively contribute to improving maternal and perinatal health in similar settings.
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Affiliation(s)
| | | | - Jacky Yabili
- Jhpiego, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hannah Tappis
- Jhpiego, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lilaonitkul M, Zacharia A, Law TJ, Yusuf N, Saria P, Moore J. Evaluation of practice change following SAFE obstetric courses in Tanzania: a prospective cohort study. Anaesthesia 2023; 78:1354-1364. [PMID: 37431149 DOI: 10.1111/anae.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
Anaesthesia has been shown to contribute disproportionately to maternal mortality in low-resource settings. This figure exceeds 500 per 100,000 live births in Tanzania, where anaesthesia is mainly provided by non-physician anaesthetists, many of whom are working as independent practitioners in rural areas without any support or opportunity for continuous medical education. The three-day Safer Anaesthesia from Education (SAFE) course was developed to address this gap by providing in-service training in obstetric anaesthesia to improve patient safety. Two obstetric SAFE courses with refresher training were delivered to 75 non-physician anaesthetists in the Mbeya region of Tanzania between August 2019 and July 2020. To evaluate translation of knowledge into practice, we conducted direct observation of the SAFE obstetric participants at their workplace in five facilities using a binary checklist of expected behaviours, to assess the peri-operative management of patients undergoing caesarean deliveries. The observations were conducted over a 2-week period at pre, immediately post, 6-month and 12-month post-SAFE obstetric training. A total of 320 cases completed by 35 participants were observed. Significant improvements in behaviours, sustained at 12 months after training included: pre-operative assessment of patients (32% (pre-training) to 88% (12 months after training), p < 0.001); checking for functioning suction (73% to 85%, p = 0.003); using aseptic spinal technique (67% to 100%, p < 0.001); timely administration of prophylactic antibiotics (66% to 95%, p < 0.001); and checking spinal block adequacy (32% to 71%, p < 0.001). Our study has demonstrated positive sustained changes in the clinical practice amongst non-physician anaesthetists as a result of SAFE obstetric training. The findings can be used to guide development of a checklist specific for anaesthesia for caesarean section to improve the quality of care for patients in low-resource settings.
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Affiliation(s)
- M Lilaonitkul
- Department of Anesthesia and Peri-operative Care, University of California San Francisco, California, USA
| | - A Zacharia
- Mbeya Zonal Referral Hospital, University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - T J Law
- Department of Anesthesia and Peri-Operative Care, University of California San Francisco, California, USA
| | - N Yusuf
- Department of Anaesthesia, Tanga Regional Referral Hospital, Tanzania
| | - P Saria
- Department of Anesthesia, CCBRT Hospital, Dar es Salaam, Tanzania
| | - J Moore
- Department of Anaesthesia, NHS Grampian, Aberdeen, UK
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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.
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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
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Christiansen AMH, Sørensen BL, Boas IM, Bedesa T, Fekede W, Nielsen HS, Lund S. The impact of the Safe Delivery Application on knowledge and skills managing postpartum haemorrhage in a low resource setting: a cluster randomized controlled trial in West Wollega region, Ethiopia. Reprod Health 2023; 20:91. [PMID: 37328731 PMCID: PMC10273743 DOI: 10.1186/s12978-023-01635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Postpartum haemorrhage is one of the leading causes of maternal mortality in low-income countries. Improving health workers' competencies in obstetric emergencies in low-income settings, has been recognized as an important factor in preventing maternal mortality and morbidity. mHealth interventions in maternal and newborn health care has shown the potential to improve health service delivery. Strong study designs such as randomized controlled trials are missing to estimate the effectiveness of the mHealth interventions. METHODS Between August 2013 and August 2014, 70 health facilities in West Wollega Region, Ethiopia were included and randomized to intervention or control in a cluster randomized controlled trial. At intervention facilities birth attendants were provided with a smartphone with the SDA installed. Of 176 midwives and "health extension workers," 130 completed at 12 months follow-up. At baseline and after 6- and 12-months participants were assessed. Knowledge was tested by a Key Feature Questionnaire, skills by an Objective Structured Assessment of Technical Skills in a structured role-play scenario. RESULTS Baseline skills scores were low and comparable with a median of 12/100 in the intervention and the control group. After 6 months skills had doubled in the intervention group (adjusted mean difference 29.6; 95% CI 24.2-35.1 compared to 1·8; 95% CI - 2.7 to 6.3 in the control group). At 12 months skills had further improved in the intervention group (adjusted mean difference 13.3; 95% CI 8.3-18.3 compared to 3.1; 95% CI - 1.0 to 7.3 in the control group). Knowledge scores also significantly improved in the intervention group compared to the control (adjusted mean difference after 12 months 8.5; 95% CI 2.0-15.0). CONCLUSION The Safe Delivery App more than doubled clinical skills for managing postpartum haemorrhage among birth attendants making it an attractive tool to reduce maternal mortality. TRIAL REGISTRATION Clinicaltrial.gov Identifier NCT01945931. September 5, 2013.
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Affiliation(s)
| | - Bjarke Lund Sørensen
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
- Department of Obstetrics and Gynecology, University Hospital Zealand, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Ida Marie Boas
- Maternity Foundation, Forbindelsesvej 3, 2100, Copenhagen Ø, Denmark
| | - Tariku Bedesa
- Maternity Foundation, Forbindelsesvej 3, 2100, Copenhagen Ø, Denmark
| | | | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Neonatology, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Using process-oriented groups reflections with health care providers to improve childbirth care in the Democratic Republic of Congo - An implementation study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100804. [PMID: 36476783 DOI: 10.1016/j.srhc.2022.100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/11/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The ability to systematically reflect on care during labour and birth needs to be developed among health care providers. This study investigates the experiences of health care providers who have participated in process-oriented group reflections. The activity of group reflections was one of the three pillars of a training intervention seeking to implement evidence-based care routines during labour and birth that could contribute to reduced mortality and improved maternal and newborn health in the Democratic Republic of Congo (DRC). METHODS Using a qualitative approach, we interviewed 131 health care providers, in focus groups (n = 19) and individually (n = 2). Analysis of transcribed interviews was conducted using qualitative content analysis according to Elo and Kyngäs. RESULTS Group reflections added essential knowledge to the other components of the three-pillar training intervention. Through sharing and analysing care situations health care providers got increased self-awareness, tools to achieve structured and safe care routines, and to practice teamworking. CONCLUSION Using a structured model of process-oriented group reflection for health care providers on care during labour and birth proved to be a vital aspect of the training intervention, as it added knowledge to the skills gained through theoretical and simulation-based education. The three-pillar training intervention improved care routines that supported healthy births and management of complications. We recommend that structured and secure group reflections be included in similar training activities in the DRC and elsewhere, and assessed in further studies.
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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.
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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
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Nefale F, Sepeng NV, Ngunyulu R. Work-related support needs of registered nurses in a neonatal intensive care unit in the Tshwane District. Health SA 2023; 28:1764. [PMID: 36873783 PMCID: PMC9983281 DOI: 10.4102/hsag.v28i0.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background Registered nurses in neonatal intensive care units (NICU) are working under stressful environment caused by the need and commitment to provide care for the critically ill neonates. Therefore, there is an imperative need to know and understand the work-related support strategies that can be adapted for registered nurses working in a NICU in the Tshwane District to enable them to provide quality care for the admitted neonates. Aim To explore and describe the work-related support needs of registered nurses working in a specific NICU situated in the Tshwane District. Setting The study was conducted in a selected NICU in Tshwane District. Method A qualitative, exploratory, descriptive, and contextual design was used in this study. In-depth unstructured individual face-to-face interviews were conducted with nine registered nurses working at the selected NICU of an academic hospital. Thematic data analysis was conducted. Results Three themes, namely teamwork between registered nurses and doctors, staff development in the form of peer seminars, workshops and in-service training, and availability of adequate resources within the workplace arose. Conclusion This study revealed that the registered nurses working in the NICU in the Tshwane District are in need of work-related support, as it will improve their well-being. Contribution The contribution of this study will be used by the hospital management to plan strategies that can be adapted for the betterment of the work environment for registered nurses in the NICU and the hospital in general.
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Affiliation(s)
- Funzani Nefale
- Department of Nursing, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Nombulelo V Sepeng
- Department of Nursing, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Roinah Ngunyulu
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Berg M, Mwambali SN, Bogren M. Implementation of a three-pillar training intervention to improve maternal and neonatal healthcare in the Democratic Republic Of Congo: a process evaluation study in an urban health zone. Glob Health Action 2022; 15:2019391. [PMID: 35007185 PMCID: PMC8751495 DOI: 10.1080/16549716.2021.2019391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Numerous quality-improvement projects including healthcare professional training are conducted globally every year, but there is a gap between the knowledge obtained in the training and its implementation in practice and policy. A quality-improvement programme was conducted in eastern Democratic Republic of Congo (DRC) to reduce maternal and neonatal mortality and morbidity. Objective This study explores the implementation process, mechanisms of impact, and outcomes of a training intervention addressing labour and birth management and involving healthcare providers in an urban health zone in eastern part of DRC. Methods In 2019, master trainers were educated and in turn trained facilitators from seven participating healthcare facilities, which received the necessary equipment. Data comprised statistics on maternal and neonatal birth outcomes for the years before and after the training intervention, and focus group discussions (n = 18); and interviews (n = 2) with healthcare professionals, at the end of (n = 52) and after the training intervention (n = 59), respectively. The analysis was guided by a process evaluation framework, using descriptive statistics and content analysis. Results The three-pillar training intervention using a low-dose, high-frequency approach was successfully implemented in terms of fidelity, dose, adaptation, and reach. Several improved care routines were established, including improved planning, teamwork, and self-reflection skills, as well as improved awareness of the influence of the care environment, of having a respectful encounter, and of allowing a companion to be present with the birthing woman. The proportions of emergency caesareans decreased and of vaginal births increased without an increase in maternal and neonatal complications. Conclusion The findings of this study are encouraging and provide learnings for other healthcare facilities in DRC as well as other low-income countries. When designing similar training interventions, it is crucial to consider contextual factors such as incentives and to measure more salutogenic outcomes.
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Affiliation(s)
- Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Sylvie Nabintu Mwambali
- Department of Obstetrics and Gynecology, Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Nefale F, Sepeng NV, Ngunyulu R. Work-related support needs of registered nurses in a neonatal intensive care unit in the Tshwane District. Health SA 2022. [DOI: 10.4102/hsag.v27i0.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nalule Y, Pors P, Samol C, Ret S, Leang S, Ir P, Macintyre A, Dreibelbis R. A controlled before-and-after study of a multi-modal intervention to improve hand hygiene during the peri-natal period in Cambodia. Sci Rep 2022; 12:19646. [PMID: 36385113 PMCID: PMC9666993 DOI: 10.1038/s41598-022-23937-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
Abstract
Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of caregivers in both the healthcare facility and home environments are scarce. We assessed the limited efficacy of a novel multimodal behaviour change intervention, delivered at the facility, to improve the hand hygiene practices among midwives and caregivers during childbirth through the return to the home environment. The 6-month intervention was implemented in 4 of 8 purposively selected facilities and included environmental restructuring, hand hygiene infrastructure provision, cues and reminders, and participatory training. In this controlled before-and-after study, the hand hygiene practices of all caregivers present along the care continuum of 99 women and newborns were directly observed. Direct observations took place during three time periods; labour, delivery and immediate aftercare in the facility delivery room, postnatal care in the facility ward and in the home environment within the first 48 h following discharge. Multilevel logistic regression models, adjusted for baseline measures, assessed differences in hand hygiene practices between intervention and control facilities. The intervention was associated with increased odds of improved practice of birth attendants during birth and newborn care in the delivery room (Adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.7, 7.7), and that of parental and non-parental caregivers prior to newborn care in the post-natal care ward (AOR = 9.2; CI = 1.3, 66.2); however, the absolute magnitude of improvements was limited. Intervention effects were not presented for the home environment due COVID-19 related restrictions on observation duration at endline which resulted in too low observation numbers to warrant testing. Our results suggest the potential of a facility-based multimodal behaviour change intervention to improve hand hygiene practices that are critical to maternal and neonatal infection along the continuum of care.
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Affiliation(s)
- Yolisa Nalule
- grid.8991.90000 0004 0425 469XDisease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | | | | | | | - Supheap Leang
- grid.436334.5National Institute of Public Health, Phnom Penh, Cambodia
| | - Por Ir
- grid.436334.5National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Robert Dreibelbis
- grid.8991.90000 0004 0425 469XDisease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
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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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14
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Data S, Mirette D, Cherop M, Bajunirwe F, Kyakwera C, Robinson T, Josephine NN, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, McIntosh H, Cheng A. Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial. Pediatrics 2022; 150:188489. [PMID: 35794462 DOI: 10.1542/peds.2021-054471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. METHODS We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. RESULTS Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). CONCLUSIONS A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.
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Affiliation(s)
- Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dube Mirette
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Moses Cherop
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Traci Robinson
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | | | - Lenard Abesiga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tamara Namata
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jennifer L Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Margaret Twine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ian Wishart
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Heather McIntosh
- Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adam Cheng
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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15
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Bluestone J, Troncoso E, Fitzgerald L, Nagbe L, Tetteh G, Hellar A, Ernest E. Three Pivots for Improving Health Care Provider Performance. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00625. [PMID: 35294392 PMCID: PMC8885343 DOI: 10.9745/ghsp-d-21-00625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
We share recommendations on 3 important pivots away from longstanding approaches to continued professional development and in-service training programs that have demonstrated a measurable benefit across a diversity of health-related applications and projects.
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16
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Arsenault C, Rowe SY, Ross-Degnan D, Peters DH, Roder-DeWan S, Kruk ME, Rowe AK. How does the effectiveness of strategies to improve healthcare provider practices in low-income and middle-income countries change after implementation? Secondary analysis of a systematic review. BMJ Qual Saf 2022; 31:123-133. [PMID: 34006598 PMCID: PMC8784997 DOI: 10.1136/bmjqs-2020-011717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/22/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND A recent systematic review evaluated the effectiveness of strategies to improve healthcare provider (HCP) performance in low-income and middle-income countries. The review identified strategies with varying effects, including in-service training, supervision and group problem-solving. However, whether their effectiveness changed over time remained unclear. In particular, understanding whether effects decay over time is crucial to improve sustainability. METHODS We conducted a secondary analysis of data from the aforementioned review to explore associations between time and effectiveness. We calculated effect sizes (defined as percentage-point (%-point) changes) for HCP practice outcomes (eg, percentage of patients correctly treated) at each follow-up time point after the strategy was implemented. We estimated the association between time and effectiveness using random-intercept linear regression models with time-specific effect sizes clustered within studies and adjusted for baseline performance. RESULTS The primary analysis included 37 studies, and a sensitivity analysis included 77 additional studies. For training, every additional month of follow-up was associated with a 0.19 %-point decrease in effectiveness (95% CI: -0.36 to -0.03). For training combined with supervision, every additional month was associated with a 0.40 %-point decrease in effectiveness (95% CI: -0.68 to -0.12). Time trend results for supervision were inconclusive. For group problem-solving alone, time was positively associated with effectiveness, with a 0.50 %-point increase in effect per month (95% CI: 0.37 to 0.64). Group problem-solving combined with training was associated with large improvements, and its effect was not associated with time. CONCLUSIONS Time trends in the effectiveness of different strategies to improve HCP practices vary among strategies. Programmes relying solely on in-service training might need periodical refresher training or, better still, consider combining training with group problem-solving. Although more high-quality research is needed, these results, which are important for decision-makers as they choose which strategies to use, underscore the utility of studies with multiple post-implementation measurements so sustainability of the impact on HCP practices can be assessed.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Dennis Ross-Degnan
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - David H Peters
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sanam Roder-DeWan
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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17
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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.
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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
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18
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Zombre D, Kortenaar JL, Zareef F, Doumbia M, Doumbia S, Haidara F, McLaughlin K, Sow S, Bhutta ZA, Bassani DG. Combined Clinical Audits and Low-Dose, High-frequency, In-service Training of Health Care Providers and Community Health Workers to Improve Maternal and Newborn Health in Mali: Protocol for a Pragmatic Cluster Randomized Trial. JMIR Res Protoc 2021; 10:e28644. [PMID: 34889776 PMCID: PMC8709918 DOI: 10.2196/28644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Although most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. Objective This trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality. Methods The study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. Results The trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol. Conclusions The results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings. Trial Registration ClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237 International Registered Report Identifier (IRRID) DERR1-10.2196/28644
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Affiliation(s)
- David Zombre
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jean-Luc Kortenaar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Farhana Zareef
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | - Katie McLaughlin
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samba Sow
- Centre for Vaccine Development, Bamako, Mali
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Centre for Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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19
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Bogren M, Mwambali SN, Berg M. Contextual factors influencing a training intervention aimed at improved maternal and newborn healthcare in a health zone of the Democratic Republic of Congo. PLoS One 2021; 16:e0260153. [PMID: 34843565 PMCID: PMC8629278 DOI: 10.1371/journal.pone.0260153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Maternal and neonatal mortality and morbidity in the Democratic Republic of Congo (DRC) are among the highest worldwide. As part of a quality improvement programme in a health zone in the DRC aimed at contributing to reduced maternal and neonatal mortality and morbidity, a three-pillar training intervention around childbirth was developed and implemented in collaboration between Swedish and Congolese researchers and healthcare professionals. The aim of this study is to explore contextual factors influencing this intervention. Methods A qualitative research design was used, with data collected through focus group discussions (n = 7) with healthcare professionals involved in the intervention before and at the end (n = 9). Transcribed discussions were inductively analysed using content analysis. Results Three generic categories describe the contextual factors influencing the intervention: i) Incentives motivated participants’ efforts to begin a training programme; ii) Involving the local health authorities was important; and (iii) Having physical space, electricity, and equipment in place was crucial. Conclusions This study and similar ones highlight that incentives of various types are crucial contextual factors that influence training interventions, and have to be considered already in the planning of such interventions. One such factor is expectations of monetary incentives. To meet this in a small research project like ours would require a reduction of the scale and thus limit the implementation of new evidence-based knowledge into practice aimed at reducing maternal mortality and morbidity.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Sylvie Nabintu Mwambali
- Faculty of Medicine and Community Health, Department of Obstetrics and Gynecology, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Faculty of Medicine and Community Health, Department of Obstetrics and Gynecology, Evangelical University of Africa, Bukavu, Democratic Republic of Congo
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20
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Spies LA, Riley C, Nair R, Hussain N, Reddy MP. High-Frequency, Low-Dose Education to Improve Neonatal Outcomes in Low-Resource Settings: A Cluster Randomized Controlled Trial. Adv Neonatal Care 2021; 22:362-369. [PMID: 34743112 DOI: 10.1097/anc.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Annually 2.5 million infants die in the first 28 days of life, with a significant regional distribution disparity. An estimated 80% of those could be saved if neonatal resuscitation were correctly and promptly initiated. A barrier to achieving the target is the knowledge and skills of healthcare workers. PURPOSE The objective of this cluster randomized trial was to assess the improvement and retention of resuscitation skills of nurses, midwives, and birth attendants in 2 birth centers serving 60 villages in rural India using high-frequency, low-dose training. RESULTS There was a significant difference (P < .05) between the groups in the rate of resuscitation, with 18% needing resuscitation in the control group and 6% in the intervention group. The posttest scores for knowledge retention at the final 8-month evaluation were significantly better in the intervention group than in the control group (intervention group mean rank 19.4 vs control group mean rank 10.3; P < .05). The success rate of resuscitation was not significantly different among the groups. IMPLICATIONS FOR PRACTICE Improved knowledge retention at 8 months and the lower need for resuscitation in the intervention group support the efficacy of the high-frequency, low-dose education model of teaching in this setting. IMPLICATIONS FOR RESEARCH Replication of these findings in other settings with a larger population cohort is needed to study the impact of such intervention on birth outcomes in low-resource settings.
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21
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Baumgartner JN, Headley J, Kirya J, Guenther J, Kaggwa J, Kim MK, Aldridge L, Weiland S, Egger J. Impact evaluation of a maternal and neonatal health training intervention in private Ugandan facilities. Health Policy Plan 2021; 36:1103-1115. [PMID: 34184060 PMCID: PMC8359744 DOI: 10.1093/heapol/czab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 04/20/2021] [Accepted: 06/26/2021] [Indexed: 11/14/2022] Open
Abstract
Global and country-specific targets for reductions in maternal and neonatal mortality in low-resource settings will not be achieved without improvements in the quality of care for optimal facility-based obstetric and newborn care. This global call includes the private sector, which is increasingly serving low-resource pregnant women. The primary aim of this study was to estimate the impact of a clinical and management-training programme delivered by a non-governmental organization [LifeNet International] that partners with clinics on adherence to global standards of clinical quality during labour and delivery in rural Uganda. The secondary aim included describing the effect of the LifeNet training on pre-discharge neonatal and maternal mortality. The LifeNet programme delivered maternal and neonatal clinical trainings over a 10-month period in 2017-18. Direct clinical observations of obstetric deliveries were conducted at baseline (n = 263 pre-intervention) and endline (n = 321 post-intervention) for six faith-based, not-for-profit primary healthcare facilities in the greater Masaka area of Uganda. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum haemorrhage and neonatal resuscitation). Data were supplemented by daily facility-based assessments of infrastructure during the study periods. Results showed positive and clinically meaningful increases in observed handwashing, observed delayed cord clamping, partograph use documentation and observed 1- and/or 5-minute APGAR assessments (rapid scoring system for assessing clinical status of newborn), in particular, between baseline and endline. High-quality intrapartum facility-based care is critical for reducing maternal and early neonatal mortality, and this evaluation of the LifeNet intervention indicates that their clinical training programme improved the practice of quality maternal and neonatal healthcare at all six primary care clinics in Uganda, at least over a relatively short-term period. However, for several of these quality indicators, the adherence rates, although improved, were still far from 100% and could benefit from further improvement via refresher trainings and/or a closer examination of the barriers to adherence.
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Affiliation(s)
- Joy Noel Baumgartner
- School of Social Work, University of North Carolina, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Julius Kirya
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - Josh Guenther
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - James Kaggwa
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - Min Kyung Kim
- Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Luke Aldridge
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | | | - Joseph Egger
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
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22
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Ryan N, Vieira D, Goffman D, Bloch EM, Akaba GO, D'mello BS, Egekeze C, Snyder A, Lyimo M, Nnodu O, Peprah E. Implementation outcomes of policy and programme innovations to prevent obstetric haemorrhage in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 35:1208-1227. [PMID: 32995854 DOI: 10.1093/heapol/czaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 11/14/2022] Open
Abstract
Globally, obstetric haemorrhage (OH) remains the leading cause of maternal mortality. Much of the associated mortality is ascribed to challenges surrounding deployment of innovations rather than lack of availability. In low- and middle-income countries (LMICs), where the burden is highest, there is a growing interest in implementation research as a means to bridge the 'know-do' gap between proven interventions and their reliable implementation at scale. In this systematic review, we identified and synthesized qualitative and quantitative data across the implementation outcomes of OH prevention innovations in LMICs using a taxonomy developed by Proctor et al. We also identified service outcomes for the included innovations, as well as implementation strategies and implementation facilitators and barriers. Eligible studies were empirical, focused on the implementation of OH prevention programmes or policies and occurred in an LMIC. Eight databases were searched. Two authors independently assessed studies for selection and extracted data; the first author resolved discrepancies. Narrative synthesis was used to analyse and interpret the findings. Studies were predominantly focused in Africa and on primary prevention. Interventions included prophylactic use of uterotonics (n = 7), clinical provider skills training (n = 4) and provision of clinical guidelines (n = 1); some (n = 3) were also part of a multi-component quality improvement bundle. Various barriers were reported, including challenges among intervention beneficiaries, providers and within the health system; however, studies reported the development and testing of practical implementation solutions. These included training and monitoring of implementers, community and stakeholder engagement and guidance by external mentors. Some studies linked successful delivery to implementation outcomes, most commonly adoption and acceptability, but also feasibility, penetration and sustainability. Findings suggest that innovations to prevent OH can be acceptable, appropriate and feasible in LMIC settings; however, more research is needed to better evaluate these and other under-reported implementation outcomes.
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Affiliation(s)
- Nessa Ryan
- Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA
| | - Dorice Vieira
- Department of Medical Library Services, NYU Grossman School of Medicine, 577 First Avenue, 2nd Floor, Room 202, New York, NY 10016, USA
| | - Dena Goffman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 W 168th St, Rm PH16-74, New York, NY 10032, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe Street/Carnegie 446 D1, Baltimore, MD 21287, USA
| | - Godwin O Akaba
- Department of Obstetrics and Gynaecology, University of Abuja/University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Brenda S D'mello
- Maternal and Newborn Healthcare Department, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), P.O. Box 23310, Dar es Salaam, Tanzania
| | - Chioma Egekeze
- Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA
| | - Anya Snyder
- Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA
| | - Magdalena Lyimo
- National Blood Transfusion Service, Max Mbwana St, Box: 65019 DSM, Dar es Salaam, Tanzania
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, Department of Haematology, University of Abuja, Abuja, Nigeria
| | - Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA.,Department of Social and Behavioral Sciences, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA
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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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Dominico S, Kasanga M, Mwakatundu N, Chaote P, Lobis S, Bailey PE. Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania. BMC Pregnancy Childbirth 2021; 21:302. [PMID: 33853540 PMCID: PMC8048302 DOI: 10.1186/s12884-021-03738-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors. Methods A cross-sectional knowledge, attitudes and practice survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provided comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. Results Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); nurse officers, assistant nurse officers, registered nurses (32%); and enrolled nurses (44%). Eighty percent reported either pre-service, in-service vacuum extraction training or both, but only 31% reported conducting a vacuum-assisted birth in the last 3 months. Based on 11 training and enabling factors, a positive association with recent practice was observed; the single most promising factor was hands-on solo practice during in-service training (66% of providers with this experience had conducted vacuum extraction in the last 3 months). The logistic regression model showed that providers exposed to 7–9 training modalities were 7.8 times more likely to have performed vacuum extraction than those exposed to fewer training opportunities (AOR = 7.78, 95% CI: 4.169–14.524). Providers who worked in administrative councils other than Kigoma Municipality were 2.7 times more likely to have conducted vacuum extraction than their colleagues in Kigoma Municipality (AOR = 2.67, 95% CI: 1.023–6.976). Similarly, providers posted in a health center compared to those in a hospital were twice as likely to have conducted a recent vacuum extraction (AOR = 2.11, 95% CI: 1.153–3.850), and finally, male providers were twice as likely as their female colleagues to have performed this procedure recently (AOR = 1.95, 95% CI: 1.072–3.55). Conclusions Training and location of posting were associated with recent practice of vacuum extraction. Multiple training modalities appear to predict recent practice but hands-on experience during training may be the most critical component. We recommend a low-dose high frequency strategy to skills building with simulation and e-learning. A gender integrated approach to training may help ensure female trainees are exposed to critical training components. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03738-0.
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Affiliation(s)
| | | | | | - Paul Chaote
- President's Office-Regional Administration and Local Government, Dodoma, Tanzania
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Welsh J, Gross MM, Hanson C, Hounkpatin H, Moller AB. Protocol for a scoping review to identify and map in-service education and training materials for midwifery care in sub-Saharan Africa from 2000 to 2020. BMJ Open 2021; 11:e047118. [PMID: 33762249 PMCID: PMC7993216 DOI: 10.1136/bmjopen-2020-047118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Maternal and neonatal mortality are disproportionally high in low-and middle-income countries. In 2017 the global maternal mortality ratio was estimated to be 211 per 100 000 live births. An estimated 66% of these deaths occurred in sub-Saharan Africa. Training programmes that aim to prepare providers of midwifery care vary considerably across sub-Saharan Africa in terms of length, content and quality. To overcome the shortfalls of pre-service training and support the provision of quality care, in-service training packages for providers of midwifery care have been developed and implemented in many countries in sub-Saharan Africa. We aim to identify what in-service education and training materials have been used for providers of midwifery care between 2000 and 2020 and map their content to the International Confederation of Midwives' Essential Competencies for Midwifery Practice (ICM Competencies), and the Lancet Midwifery Series Quality Maternal and Newborn Care (QMNC) framework. METHODS AND ANALYSIS A search will be conducted for the years 2000-2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Sciences Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a hand search of literature from international partner organisations will be performed. Information retrieved will include study context, providers trained, focus of training and design of training. Original content of identified education and training materials will be obtained and mapped to the ICM Competencies and the Lancet Series QMNC. ETHICS AND DISSEMINATION A scoping review is a secondary analysis of published literature and does not require ethical approval. This scoping review will give an overview of the education and training materials used for in-service training for providers of midwifery care in sub-Saharan Africa. Mapping the content of these education and training materials to the ICM Competencies and The Lancet Series QMNC will allow us to assess their appropriateness. Findings from the review will be reflected to stakeholders involved in the design and implementation of such materials. Additionally, findings will be published in a peer-reviewed journal, and used to inform the design and content of an in-service training package for providers of midwifery care as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) study, (https://alert.ki.se/) a multi-country study in Benin, Malawi, Tanzania and Uganda. TRIAL REGISTRATION NUMBER PACTR202006793783148; Post-results.
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Affiliation(s)
- Joanne Welsh
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Ann-Beth Moller
- School of Public Health and Community, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Using simulation team training with human's factors components in obstetrics to improve patient outcome: A review of the literature. Eur J Obstet Gynecol Reprod Biol 2021; 260:159-165. [PMID: 33784580 DOI: 10.1016/j.ejogrb.2021.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to assess the evidence from multidisciplinary simulation team training in obstetrics that integrates human's factors components on patient outcome. INTRODUCTION It has been stated that simulation-based education has the potential to improve technical and nontechnical skills. Reports from enquiries into maternal and newborn adverse outcomes, highlight that the majority of incidents are due to a breakdown of communication and a lack of crisis resource management skills (CRM). It is therefore reasonable to think that a better training on teamwork based on simulation will ultimately improve obstetrics care. In order to explore further that idea, we conducted a literature review on patient outcome after a multidisciplinary simulation training in obstetrics. METHOD Pubmed, Advances in health sciences education, BMC in medical education, BMC in pregnancy and Childbirth, BMJ open, BMJ Simulation and technology enhanced learning were searched from inception to May 2020 for full-text publications in English on interprofessional, multidisciplinary, obstetrics, simulation training, non-technical skills, CRM. Searches were limited to studies with a report on patient outcome after a multidisciplinary simulation program that included elements of CRM. RESULT Out of the ten studies selected in our review, five were single site before and after prospective studies and five were cluster before and after randomized trials. All the single site studies reported a positive outcome in low and high resource countries. Three single site studies reported a reduction between 41 and 50 % of blood transfusion after simulation team training. Two single studies reported a reduction of maternal mortality by 34 % and a decrease in an adverse obstetrics index outcome from 0.052 to 0.048 with a p-value of 0.05. Cluster studies showed either no change or some improvement in patient outcomes such as a 37 % improvement on weighted obstetrics adverse outcome, a 17 % reduction in the incidence of PPH and a 47 % reduction in the incidence of retained placenta. Stillbirths rate was reduced by 34 % while newborn deaths was down by 62 %. There was also a 15 % reduction of maternal mortality in favor of the trained team after adjustment to the secular mortality trend. Neonatal death from 24 weeks during the first 24 h was also reduced by 83 % in the intervention site compare with an increase by 18 % in the control site. CONCLUSION There is evidence that simulation team training that includes CRM is associated with better patient outcome. In order to consolidate this finding, appropriate methodology should be used in future studies with the support of health authorities.
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Chan NHM, Merali HS, Mistry N, Kealey R, Campbell DM, Morris SK, Data S. Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda. BMC Med Inform Decis Mak 2021; 21:39. [PMID: 33541340 PMCID: PMC7863544 DOI: 10.1186/s12911-021-01406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Helping Babies Breathe (HBB) is a life-saving program that has helped reduce neonatal morbidity and mortality, but knowledge and skills retention after training remains a significant challenge for sustainability of impact. User-centred design (UCD) can be used to develop solutions to target knowledge and skills maintenance. METHODS We applied a process of UCD beginning with understanding the facilitators of, and barriers to, learning and retaining HBB knowledge and skills. HBB Master Trainers and frontline HBB providers participated in a series of focus group discussions (FGDs) to uncover the processes of skills acquisition and maintenance to develop a mobile application called "HBB Prompt". Themes derived from each FGD were identified and implications for development of the HBB Prompt app were explored, including feasibility of incorporating strategies into the format of an app. Data analysis took place after each iteration in Phase 1 to incorporate feedback and improve subsequent versions of HBB Prompt. RESULTS Six HBB trainers and seven frontline HBB providers participated in a series of FGDs in Phase 1 of this study. Common themes included lack of motivation to practise, improving confidence in ventilation skills, ability to achieve the Golden Minute, fear of forgetting knowledge or skills, importance of feedback, and peer-to-peer learning. Themes identified that were not feasible to address pertained to health system challenges. Feedback about HBB Prompt was generally positive. Based on initial and iterative feedback, HBB Prompt was created with four primary functions: Training Mode, Simulation Mode, Quizzes, and Dashboard/Scoreboard. CONCLUSIONS Developing HBB Prompt with UCD to help improve knowledge and skills retention was feasible and revealed key concepts, including drivers for successes and challenges faced for learning and maintaining HBB skills. HBB Prompt will be piloted in Phase 2 of this study, where knowledge and skills retention after HBB training will be compared between an intervention group with HBB Prompt and a control group without the app. Trial registration Clinicaltrials.gov (NCT03577054). Retrospectively registered July 5, 2018, https://clinicaltrials.gov/ct2/show/study/NCT03577054 .
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Affiliation(s)
- Natalie Hoi-Man Chan
- Division of Neonatology, British Columbia Women’s Hospital, 1N55-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Hasan S. Merali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children’s Hospital, 1280 Main Street West, HSC-2R104, Hamilton, ON L8S 4K1 Canada
| | - Niraj Mistry
- Division of Paediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, 5 King’s College Road, Toronto, ON M5S 3G8 Canada
- Design Research, TD Bank Group, Toronto, ON Canada
| | - Douglas M. Campbell
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON Canada
- Neonatal Intensive Care Unit, St. Michael’s Hospital, 15014 - 30 Bond St, Toronto, M5B 1W8 ON Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Shaun K. Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Consortium for Affordable Medical Technologies in Uganda (CAMTech Uganda), Mbarara, Uganda
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Hanson C, Atuhairwe S, Lucy Atim J, Marrone G, Morris JL, Kaharuza F. Effects of the Helping Mothers Survive Bleeding after Birth training on near miss morbidity and mortality in Uganda: A cluster-randomized trial. Int J Gynaecol Obstet 2020; 152:386-394. [PMID: 32981091 PMCID: PMC7894512 DOI: 10.1002/ijgo.13395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022]
Abstract
Objective To assess the effect of Helping Mothers Survive Bleeding after Birth training on postpartum hemorrhage (PPH) near miss and case fatality rates in Uganda. Methods Training was evaluated using a cluster‐randomized design between June 2016 and September 2017 in 18 typical rural districts (clusters) in Eastern and Central Uganda of which nine districts were randomly assigned to the intervention. The main outcome was PPH near miss defined using the World Health Organization’s disease and management‐based approach. Interrupted time series analysis was performed to estimate the difference in the change of outcomes. Results Outcomes of 58 000 and 95 455 deliveries during the 6‐month baseline and 10‐month endline periods, respectively, were included. A reduction of PPH near misses was observed in the intervention compared to the comparison districts (difference‐in‐difference of slopes 4.19, 95% CI, –7.64 to –0.74); P<0.05). There was an increase in overall reported near miss cases (difference‐in‐difference 1.24, 95% CI, 0.37–2.10; P<0.001) and an increase in PPH case fatality rate (difference‐in‐difference 2.13, 95% CI, 0.14–4.12; P<0.05). Conclusion This pragmatic cluster‐randomized trial conducted in typical rural districts of Uganda indicated a reduction of severe PPH cases while case fatality did not improve, suggesting that this basic training needs to be complemented by additional measures for sustained mortality reduction. Trial registration: PACTR201604001582128.
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Affiliation(s)
- Claudia Hanson
- Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Atuhairwe
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda.,Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda
| | - Joyce Lucy Atim
- Mbale Regional Referral Hospital, Mbale, Uganda.,Uganda Nurses and Midwives Union, Kampala, Uganda
| | - Gaetano Marrone
- Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jessica L Morris
- FIGO (International Federation of Gynecology and Obstetrics), London, UK
| | - Frank Kaharuza
- Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda.,Makerere University School of Public Health, Kampala, Uganda
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Bogren M, Denovan A, Kent F, Berg M, Linden K. Impact of the Helping Mothers Survive Bleeding After Birth learning programme on care provider skills and maternal health outcomes in low-income countries - An integrative review. Women Birth 2020; 34:425-434. [PMID: 33041235 DOI: 10.1016/j.wombi.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To improve maternal health outcomes, highly competent healthcare providers are needed. One strategy used to improve performance among healthcare providers is simulation-based learning. An integrative review was designed with the aim of synthesising available research on Helping Mothers Survive (HMS), a learning programme used in low-income countries, and its impact on care provider skills and maternal health outcomes. METHOD A systematic search was conducted in June 2020 in CINAHL, PubMed, Scopus, and Web of Science. All stages of inclusion, quality assessment, and data extraction were done independently by four reviewers. A narrative synthesis was used for the outcomes of care provider skills and knowledge, as well as maternal health outcomes. FINDINGS The search identified 50 articles, 22 of which were excluded due to being duplicates, 16 based on their title and abstract, and two based on their full text. Eleven papers were included in the synthesis: eight quantitative, two qualitative, and one mixed-method study, originating from India, Malawi, Tanzania, Uganda, and Zanzibar. The Helping Mothers Survive-Bleeding After Birth (HMS-BAB) learning programme was found to have a positive impact on care providers' competencies and maternal health outcomes, with a reduced number of postpartum haemorrhages and a reduction in maternal mortality. CONCLUSION The HMS-BAB learning programme has the potential to increase competence among care providers and improve maternal health outcomes in low-income settings. A successful use of the programme to maintain improved care routines for mothers requires multi-professional teams, facility readiness, a low-dose high-frequency approach, a local coordinator, and accountability and ownership.
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Affiliation(s)
- Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden.
| | - Anna Denovan
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
| | - Felicity Kent
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe 1, 413 46 Gothenburg, Sweden
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Patterson JK, Girnary S, North K, Data S, Ishoso D, Eilevstjønn J, Bose CL. Innovations in Cardiorespiratory Monitoring to Improve Resuscitation With Helping Babies Breathe. Pediatrics 2020; 146:S155-S164. [PMID: 33004638 DOI: 10.1542/peds.2020-016915h] [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
Ninety percent of intrapartum-related neonatal deaths are attributable to respiratory depression, with the vast majority of these deaths occurring in low- and lower-middle-income countries. Neonatal resuscitation training with Helping Babies Breathe (HBB) decreases mortality from respiratory depression. Cardiorespiratory monitoring in conjunction with HBB can provide valuable resuscitation feedback for both training and bedside purposes. In this article, we discuss 3 innovations that couple cardiorespiratory monitoring with HBB: NeoNatalie Live, the Augmented Infant Resuscitator, and NeoBeat. NeoNatalie Live is a high-fidelity manikin that facilitates bag mask ventilation training through case scenarios of varying difficulty. The Augmented Infant Resuscitator is added in-line between a face mask and ventilation bag during bag mask ventilation training to provide users with real-time feedback on ventilation quality. NeoBeat is a battery-operated heart rate meter that digitally displays the newborn heart rate during bedside resuscitations. For each innovation, we review details of the device, implementation in the field, and areas for further research. Using early experience implementing these devices, we suggest building blocks for effective translation of training into improved care. We also highlight general challenges in implementation of devices in facilities in low- and lower-middle-income countries including considerations for training, adaptations to existing workflow, and integration into the ecosystem. Although the devices highlighted in this article hold promise, more data are needed to understand their impact on newborn outcomes.
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Affiliation(s)
- Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Krysten North
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda; and
| | - Daniel Ishoso
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Carl L Bose
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Niermeyer S, Little GA, Singhal N, Keenan WJ. A Short History of Helping Babies Breathe: Why and How, Then and Now. Pediatrics 2020; 146:S101-S111. [PMID: 33004633 DOI: 10.1542/peds.2020-016915c] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Helping Babies Breathe (HBB) changed global education in neonatal resuscitation. Although rooted in the technical and educational expertise underpinning the American Academy of Pediatrics' Neonatal Resuscitation Program, a series of global collaborations and pivotal encounters shaped the program differently. An innovative neonatal simulator, graphic learning materials, and content tailored to address the major causes of neonatal death in low- and middle-income countries empowered providers to take action to help infants in their facilities. Strategic dissemination and implementation through a Global Development Alliance spread the program rapidly, but perhaps the greatest factor in its success was the enthusiasm of participants who experienced the power of being able to improve the outcome of babies. Collaboration continued with frontline users, implementing organizations, researchers, and global health leaders to improve the effectiveness of the program. The second edition of HBB not only incorporated new science but also the accumulated understanding of how to help providers retain and build skills and use quality improvement techniques. Although the implementation of HBB has resulted in significant decreases in fresh stillbirth and early neonatal mortality, the goal of having a skilled and equipped provider at every birth remains to be achieved. Continued collaboration and the leadership of empowered health care providers within their own countries will bring the world closer to this goal.
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Affiliation(s)
- Susan Niermeyer
- Section of Neonatology, Department of Pediatrics, School of Medicine, University of Colorado and Colorado School of Public Health, Aurora, Colorado;
| | - George A Little
- Departments of Pediatrics and Obstetrics and Gynecology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Nalini Singhal
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and
| | - William J Keenan
- Division of Neonatal and Perinatal Medicine, Saint Louis University, St Louis, Missouri
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32
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Evans CL, Kamunya R, Tibaijuka G. Using Helping Mothers Survive to Improve Intrapartum Care. Pediatrics 2020; 146:S218-S222. [PMID: 33004643 DOI: 10.1542/peds.2020-016915m] [Citation(s) in RCA: 0] [Impact Index Per Article: 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
Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.
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Singhal N, McMillan DD, Savich R, Matovelo D, Santorino D, Kamath-Rayne BD. Development and Impact of Helping Babies Breathe Educational Methodology. Pediatrics 2020; 146:S123-S133. [PMID: 33004635 DOI: 10.1542/peds.2020-016915e] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The educational pedagogy surrounding Helping Babies Breathe (HBB) has been transformative in going beyond a curriculum focused only on basic neonatal resuscitation; indeed, it created the framework for an educational program that has served as a model for replication for other impactful programs, such as the Helping Mothers Survive and other Helping Babies Survive curricula. The tenets of HBB include incorporation of innovative learning strategies such as small group discussion, skills-based learning, simulation and debriefing, and peer-to-peer learning, all of which begin the hard work of changing behaviors that may eventually affect health care systems. Allowing for adaptation for local resources and culture, HBB has catalyzed innovation in the development of simplified, pictorial educational materials, in addition to low-tech yet realistic simulators and adjunct devices that have played an important role in empowering health care professionals in their care of newborns, thereby improving outcomes. In this review, we describe the development of HBB as an educational program, the importance of field testing and input from multiple stakeholders including frontline workers, the strategies behind the components of educational materials, and the impact of its pedagogy on learning.
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Affiliation(s)
- Nalini Singhal
- Department of Pediatrics University of Calgary, Calgary, Canada;
| | - Douglas D McMillan
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Renate Savich
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Dismas Matovelo
- Department of Obstetrics and Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Data Santorino
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda; and
| | - Beena D Kamath-Rayne
- Global Health and Life Support and American Academy of Pediatrics, Itasca, Illinois
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Comparing the impacts of reciprocal peer teaching with faculty teaching: A single-centre experience from KSA. J Taibah Univ Med Sci 2020; 15:272-277. [PMID: 32982630 PMCID: PMC7479164 DOI: 10.1016/j.jtumed.2020.05.006] [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: 01/27/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study aimed to compare the effectiveness of peer-led learning with faculty-led teaching activities in fifth-year students during their Internal Medicine II placement. METHODS We conducted a retrospective analysis of the results of multiple-choice questions exams at the end-of-placement for 2016 to 2017. RESULTS During the study period, 120 students in three cohorts completed the placement. There was a statistically significant difference (p < .001) between the mean student grade (% of correct answers) for questions related to lectures (n = 85, M = 68.7, 95% CI: 66.4-70.9), case scenarios (n = 24, M = 68.6, CI: 65.1-72.1), tutorials (n = 15, M = 64.9, CI: 59.9-69.8), and seminars (n = 24, M = 60.0, CI: 56.5-63.5). The first cohort had statistically significant better grades (M = 79.7, CI: 77.9-81.6) than the other two cohorts (group 2 M = 57.2, CI: 51.8-62.5; group 3 M = 60.5, CI: 58.1-63.0; p < .001). CONCLUSIONS In our study, students performed worse on questions drawn from reciprocal peer-taught seminars. This result could be attributed to students' poor teaching quality, as they were randomly selected to lead a seminar. However, this study was limited by heterogeneity in the number and topics of different teaching activities and certain other factors.
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Ugwa E, Kabue M, Otolorin E, Yenokyan G, Oniyire A, Orji B, Okoli U, Enne J, Alobo G, Olisaekee G, Oluwatobi A, Oduenyi C, Aledare A, Onwe B, Ishola G. Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers on day of birth care in Nigeria; a cluster randomized controlled trial. BMC Health Serv Res 2020; 20:586. [PMID: 32590979 PMCID: PMC7318405 DOI: 10.1186/s12913-020-05450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to compare health workers knowledge and skills competencies between those trained using the onsite simulation-based, low-dose, high frequency training plus mobile mentoring (LDHF/m-mentoring) and the ones trained through traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period. Methods A prospective cluster randomized controlled trial was conducted by enrolling 299 health workers who provided healthcare to mothers and their babies on the day of birth in 60 health facilities in Kogi and Ebonyi states. These were randomized to either LDHF/m-mentoring (intervention, n = 30 facilities) or traditional group-based training (control, n = 30 facilities) control arm. They received Basic Emergency Obstetrics and Newborn Care (BEmONC) training with simulated practice using anatomic models and role-plays. The control arm was trained offsite while the intervention arm was trained onsite where they worked. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions (MCQs) and objective structured clinical examinations (OSCEs) mean scores were compared; p-value < 0.05 was considered statistically significant. Qualitative data were also collected and content analysis was conducted. Results The mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at end line (p < 0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p < 0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities. Conclusion The LDHF/m-mentoring intervention is more effective than TRAD approach in improving health workers’ skills acquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery. Trial registration The trial was retrospectively registered on August 24, 2017 at ClinicalTrials.Gov: NCT03269240.
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Affiliation(s)
- Emmanuel Ugwa
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria.
| | - Mark Kabue
- USAID's Maternal and Child Survival Program/Jhpiego-, 1615 Thames St, Baltimore, MD, 21231, USA
| | - Emmanuel Otolorin
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Gayane Yenokyan
- The Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Adetiloye Oniyire
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Bright Orji
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Ugo Okoli
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Joseph Enne
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Gabriel Alobo
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Gladys Olisaekee
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Adebayo Oluwatobi
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Chioma Oduenyi
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Adekunle Aledare
- Department of Public Health, State Ministry of Health, Lokoja, Kogi State, Nigeria
| | - Boniface Onwe
- Department of Public Health, State Ministry of Health, Abakiliki, Ebonyi State, Nigeria
| | - Gbenga Ishola
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
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Lilaonitkul M, Mishra S, Pritchard N, Andhoga J, Olang' P, Kibet EB, Walker IA, Hart J, Byrne-Davis L. Mixed methods analysis of factors influencing change in clinical behaviours of non-physician anaesthetists in Kenya following obstetric anaesthesia training. Anaesthesia 2020; 75:1331-1339. [PMID: 32436211 DOI: 10.1111/anae.15091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Abstract
Maternal mortality rates in low-middle income countries remain high, with sub-Saharan Africa accounting for two-thirds of global maternal deaths. Inadequate staff training is one of the main contributors to anaesthesia-related deaths and the Association of Anaesthetists developed the Safe Anaesthesia from Education course in collaboration with the World Federation of Societies of Anaesthesiologists to address this training gap. We aimed to evaluate the impact of this course among Kenyan participants. Mixed methodologies and secondary analyses of anonymised data were used to study translation of learning into practice. In total, 103 participants from 66 facilities who attended courses between 2016 and 2017 were analysed. Ninety (87%) participants who were followed up completed knowledge tests. Baseline median (IQR [range]) knowledge test score was 41 (37-43 [21-46]). There was a significant improvement in median (IQR [range]) knowledge test score immediately post-course (43 (41-45 [33-48]); p < 0.001) which was sustained at 3-6 month follow-up (43 (41-45 [32-50]); p < 0.001 compared with baseline). Eighty-four of the 103 participants were observed in their workplace and capability, opportunity and motivation-behaviour framework was used to study the barriers and facilitators to practice change. Psychological capability and reflective motivation were the main factors enabling positive behaviour change such as team communication and pre-operative assessment, whereas physical and social opportunity accounted for the main barriers to behaviours such as performing the surgical safety checklist. Our study demonstrates that the Safe Anaesthesia from Education obstetric course is relevant in the low-resource setting and may lead to knowledge translation in clinical practice.
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Affiliation(s)
- M Lilaonitkul
- Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA
| | - S Mishra
- Department of Internal Medicine, Lincoln Medicine Center, New York, NY, USA
| | - N Pritchard
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Andhoga
- Department of Anaesthesia, Jomo Kenyatta University of Agriculture and Technology, Kiambu, Kenya
| | - P Olang'
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
| | - E B Kibet
- Department of Anaesthesia, Kenyatta National Hospital, Nairobi, Kenya
| | - I A Walker
- University College London Institute of Child Health, London, UK
| | - J Hart
- Division of Medical Education, University of Manchester, Manchester, UK
| | - L Byrne-Davis
- Division of Medical Education, University of Manchester, UK
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Alwy Al-beity F, Pembe AB, Marrone G, Baker U, Hanson C. Predictors of change of health workers' knowledge and skills after the Helping Mothers Survive Bleeding after Birth (HMS BAB) in-facility training in Tanzania. PLoS One 2020; 15:e0232983. [PMID: 32421737 PMCID: PMC7234376 DOI: 10.1371/journal.pone.0232983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics. METHODS Nested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics. RESULTS Of the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training. CONCLUSION Our study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics.
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Affiliation(s)
- Fadhlun Alwy Al-beity
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
- * E-mail:
| | - Andrea Barnabas Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
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Higgins BV, Medvedev MM, Spindler H, Ghosh R, Longkumer O, Cohen SR, Das A, Gore A, Mahapatra T, Walker DM. Cohort study of neonatal resuscitation skill retention in frontline healthcare facilities in Bihar, India, after PRONTO simulation training. BMJ Paediatr Open 2020; 4:e000628. [PMID: 32399505 PMCID: PMC7204812 DOI: 10.1136/bmjpo-2019-000628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Use of simulation in neonatal resuscitation (NR) training programmes has increased throughout low-income and middle-income countries. Many of such programmes have demonstrated a positive impact on NR knowledge and skill acquisition along with reduction of early neonatal mortality and fresh stillbirth rates. However, NR skill retention after simulation programmes remains a challenge. METHODS This study assessed facility level NR skill retention after PRONTO International's simulation training in Bihar, India. Training was conducted within CARE India's statewide in-job, on-site Apatkaleen Matritva evam Navjat Tatparta mentoring programme as part of a larger quality improvement and health systems strengthening initiative. Public sector facilities were initially offered training, facilitated by trained nursing graduates, during 8-month phases between September 2015 and January 2017. Repeat training began in February 2018 and was facilitated by peers. NR skills in simulated resuscitations were assessed at the facility level at the midpoint and endpoint of initial training and prior to and at the midpoint of repeat training. RESULTS Facilities administering effective positive pressure ventilation and assessing infant heart rate increased (31.1% and 13.1%, respectively, both p=0.03) from midinitial to postinitial training (n=64 primary health centres (PHCs) and 192 simulations). This was followed by a 26.2% and 20.9% decline in these skills respectively over the training gap (p≤0.01). A significant increase (16.1%, p=0.04) in heart rate assessment was observed by the midpoint of repeat training with peer facilitators (n=45 PHCs and 90 simulations). No significant change was observed in other skills assessed. CONCLUSIONS Despite initial improvement in select NR skills, deterioration was observed at a facility-level post-training. Given the technical nature of NR skills and the departure these skills represent from traditional practices in Bihar, refresher trainings at shorter intervals are likely necessary. Very limited evidence suggests peer simulation facilitators may enable such increased training frequency, but further study is required.
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Affiliation(s)
- Brennan V Higgins
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Melissa M Medvedev
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Susanna R Cohen
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Dilys M Walker
- School of Medicine and Department of Obstetrics-Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Abstract
Approximately 1 in 10 newborns will require basic resuscitation interventions at birth. Some infants progress to require more advanced measures including the provision of positive pressure ventilation, chest compressions, intubation and administration of volume/cardiac medications. Although advanced resuscitation is infrequent, it is crucial that personnel adequately trained in these techniques are available to provide such resuscitative measures. In 2000, Louis Halmalek et al. called for a "New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment." This was one of the first articles to highlight simulation as a method of teaching newborn resuscitation. The last decades have seen an exponential growth in the area of simulation in newborn care, in particular in newborn resuscitation and stabilization. Simulation is best defined as an instructional strategy "used to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner." Simulation training has now become an important point of how we structure training and deliver improved healthcare to patients. Some of the key aspects of simulation training include feedback, deliberate practice, outcome measurement, retention of skills and curriculum integration. The term "Train to win" is often used in sporting parlance to define how great teams succeed. The major difference between sports teams is that generally their game day comes once a week, whereas in newborn resuscitation every day is potentially "game day." In this review we aim to summarize the current evidence on the use of simulation based education and training in neonatal resuscitation, with particular emphasis on the evidence supporting its effectiveness. We will also highlight recent advances in the development of simulation based medical education in the context of newborn resuscitation to ensure we "train to win."
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Affiliation(s)
- Aisling A Garvey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland.,INFANT Research Centre, Cork, Ireland
| | - Eugene M Dempsey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland.,INFANT Research Centre, Cork, Ireland
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Niermeyer S. Improving Global Newborn Survival: Building upon Helping Babies Breathe. Neonatology 2020; 117:211-216. [PMID: 32454483 DOI: 10.1159/000507025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/19/2022]
Abstract
Achieving the targets of the Every Newborn Action Plan by the year 2030 will require accelerating the current reduction in neonatal mortality. Educational programs addressing the three major causes of neonatal death - intrapartum-related events (asphyxia), prematurity and small size at birth, and infection - have the potential to significantly reduce preventable mortality. Helping Babies Breathe is an example of an educational program that not only has given health care providers around the world access to current resuscitation science but has changed provider behavior and patient outcomes and resulted in perinatal quality improvement in small- and large-scale trials. However, to realize impact on neonatal mortality at the population level, perinatal educational programs that comprehensively address all aspects of essential newborn care must be implemented at scale with high coverage and quality.
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Affiliation(s)
- Susan Niermeyer
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA,
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Merriel A, Ficquet J, Barnard K, Kunutsor SK, Soar J, Lenguerrand E, Caldwell DM, Burden C, Winter C, Draycott T, Siassakos D. The effects of interactive training of healthcare providers on the management of life-threatening emergencies in hospital. Cochrane Database Syst Rev 2019; 9:CD012177. [PMID: 31549741 PMCID: PMC6757513 DOI: 10.1002/14651858.cd012177.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preparing healthcare providers to manage relatively rare life-threatening emergency situations effectively is a challenge. Training sessions enable staff to rehearse for these events and are recommended by several reports and guidelines. In this review we have focused on interactive training, this includes any element where the training is not solely didactic but provides opportunity for discussions, rehearsals, or interaction with faculty or technology. It is important to understand the effective methods and essential elements for successful emergency training so that resources can be appropriately targeted to improve outcomes. OBJECTIVES To assess the effects of interactive training of healthcare providers on the management of life-threatening emergencies in hospital on patient outcomes, clinical care practices, or organisational practices, and to identify essential components of effective interactive emergency training programmes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and ERIC and two trials registers up to 11 March 2019. We searched references of included studies, conference proceedings, and contacted study authors. SELECTION CRITERIA We included randomised trials and cluster-randomised trials comparing interactive training for emergency situations with standard/no training. We defined emergency situations as those in which immediate lifesaving action is required, for example cardiac arrests and major haemorrhage. We included all studies where healthcare workers involved in providing direct clinical care were participants. We excluded studies outside of a hospital setting or where the intervention was not targeted at practicing healthcare workers. We included trials irrespective of publication status, date, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane and Cochrane Effective Practice and Organisation of Care (EPOC) Group. Two review authors independently extracted data and assessed the risk of bias of each included trial. Due to the small number of studies and the heterogeneity in outcome measures, we were unable to perform the planned meta-analysis. We provide a structured synthesis for the following outcomes: survival to hospital discharge, morbidity rate, protocol or guideline adherence, patient outcomes, clinical practice outcomes, and organisation-of-care outcomes. We used the GRADE approach to rate the certainty of the evidence and the strength of recommendations for each outcome. MAIN RESULTS We included 11 studies that reported on 2000 healthcare providers and over 300,000 patients; one study did not report the number of participants. Seven were cluster randomised trials and four were single centre studies. Four studies focused on obstetric training, three on obstetric and neonatal care, two on neonatal training, one on trauma and one on general resuscitations. The studies were spread across high-, middle- and low-income settings.Interactive training may make little or no difference in survival to hospital discharge for patients requiring resuscitation (1 study; 30 participants; 98 events; low-certainty evidence). We are uncertain if emergency training changes morbidity rate, as the certainty of the evidence is very low (3 studies; 1778 participants; 57,193 patients, when reported). We are uncertain if training alters healthcare providers' adherence to clinical protocols or guidelines, as the certainty of the evidence is very low (3 studies; 156 participants; 558 patients). We are uncertain if there were improvements in patient outcomes following interactive training for emergency situations, as we assessed the evidence as very low-certainty (5 studies, 951 participants; 314,055 patients). We are uncertain if training for emergency situations improves clinical practice outcomes as the certainty of the evidence is very low (4 studies; 1417 participants; 28,676 patients, when reported). Two studies reported organisation-of-care outcomes, we are uncertain if interactive emergency training has any effect on this outcome as the certainty of the evidence is very low (634 participants; 179,400 patient population).We examined prespecified subgroups and found no clear commonalities in effect of multidisciplinary training, location of training, duration of the course, or duration of follow-up. We also examined areas arising from the studies including focus of training, proportion of staff trained, leadership of intervention, and incentive/trigger to participate, and again identified no clear mediating factors. The sources of funding for the studies were governmental, local organisations, or philanthropic donors. AUTHORS' CONCLUSIONS We are uncertain if there are any benefits of interactive training of healthcare providers on the management of life-threatening emergencies in hospital as the certainty of the evidence is very low. We were unable to identify any factors that may have allowed us to identify an essential element of these interactive training courses.We found a lack of consistent reporting, which contributed to the inability to meta-analyse across specialities. More trials are required to build the evidence base for the optimum way to prepare healthcare providers for rare life-threatening emergency events. These trials need to be conducted with attention to outcomes important to patients, healthcare providers, and policymakers. It is vitally important to develop high-quality studies adequately powered and with attention to minimising the risk of bias.
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Affiliation(s)
- Abi Merriel
- University of BristolPopulation Health Sciences, Bristol Medical SchoolDepartment of Women's and Children's HealthThe ChilternsBristolUKBS10 5NB
| | - Jo Ficquet
- Royal United Hospital NHS Foundation TrustWomen and Children's DivisionCoombe ParkBathUKBA1 3NG
| | - Katie Barnard
- North Bristol TrustLearning and Research, Southmead HospitalBristolUKBS10 5NB
| | - Setor K Kunutsor
- University of BristolTranslational Health Sciences, Bristol Medical SchoolBristolUK
| | - Jasmeet Soar
- North Bristol NHS Trust, Southmead HospitalAnaesthetic DepartmentBristolUKBS10 5NB
| | - Erik Lenguerrand
- University of BristolTranslational Health Sciences, Bristol Medical SchoolBristolUK
| | - Deborah M Caldwell
- University of BristolPopulation Health Sciences, Bristol Medical SchoolDepartment of Women's and Children's HealthThe ChilternsBristolUKBS10 5NB
| | - Christy Burden
- University of BristolPopulation Health Sciences, Bristol Medical SchoolDepartment of Women's and Children's HealthThe ChilternsBristolUKBS10 5NB
| | - Cathy Winter
- North Bristol NHS TrustDepartment of Women's HealthBristolUK
| | - Tim Draycott
- North Bristol NHS TrustDepartment of Women's HealthBristolUK
| | - Dimitrios Siassakos
- University College LondonUCL EGA Institute for Women's Health86‐96 Chenies MewsBloomsburyLondonUKWC1E 6HX
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Simulation-Based Training in Measurement of Blood Pressure: A Randomized Study of Impact in Real-Life Settings. Simul Healthc 2019; 14:293-299. [PMID: 31490862 DOI: 10.1097/sih.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Simulators are used for training competencies including blood pressure (BP) measurement. Whether such training translates to competency in real life is unclear. METHODS We randomized 145 first-year undergraduate medical students to train on a BP simulator or arms of colleagues. After training, all students were assessed for accuracy (within 4 mm Hg above or below assessor's simultaneous recording) and methodology of BP recordings by an objectively structured clinical examination on real patients. RESULTS Overall, 67 (46.2%) and 92 (63.4%) students accurately measured systolic and diastolic BP, respectively. Forty-three (58.1%) of 74 students in the conventional training recorded systolic BP accurately compared with 24 (33.8%) of 71 students in simulator training (P = 0.005). Diastolic BP was accurately recorded by 56 (75.7%) of 74 students in conventional group as against 36 (50.7%) of 71 students trained on simulator (P = 0.002). Median (interquartile range) objectively structured clinical examination score in conventional group was 8 (7-9) compared with 6 (5-7) in simulator group (P < 0.001). CONCLUSIONS Simulator-based training did not translate to clinical competence in terms of accuracy and methodology of BP recordings in real-life settings. Notwithstanding its advantages, simulator-based BP training needs integration with human element to make it meaningful and relevant to clinical practice.
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Asiedu A, Nelson AR, Gomez PP, Tappis H, Effah F, Allen C. "It builds your confidence… you've done well": Healthcare workers' experiences of participating in a low-dose, high-frequency training to improve newborn survival on the day of birth in Ghana. Gates Open Res 2019; 3:1470. [PMID: 31410394 DOI: 10.12688/gatesopenres.12936.1/doi] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 05/29/2023] Open
Abstract
Background: The majority of newborn deaths occur during the first week of life, and 25‒45% occur within the first 24 hours. A low-dose, high-frequency (LDHF) training approach was introduced in 40 hospitals in Ghana to improve newborn survival. The aim of this qualitative study was to explore healthcare workers' experiences with the LDHF approach to in-service training. Methods: A total of 20 in-depth interviews and nine focus group discussions were conducted in 2016 in three regions of Ghana with healthcare workers who participated in implementation of the LDHF training approach. In-depth interviews were conducted with 20 master mentors and peer practice coordinators; 51 practicing doctors, midwives and nurses participated in focus group discussions. Data were analyzed using a thematic analysis approach. Results: Healthcare workers reflected on the differences between the LDHF approach and past learning experiences, highlighting how the skills-based team training approach, coupled with high-frequency practice and mobile mentoring, built their competency and confidence. As participants shared their experiences, they highlighted relationships established between Master Mentors and healthcare workers, and motivation stemming from pride in contributing to reductions in maternal and newborn deaths as critical factors in improving quality of care at participating health facilities. Conclusion: This nested qualitative study documents experiences of healthcare workers and mentors involved in implementation of a multi-faceted intervention that effectively improved maternal and newborn care at health facilities in Ghana. The way the intervention was implemented created an environment conducive to learning within the hospital setting, thus providing an opportunity for professional growth and quality improvement for all staff working in the maternity ward.
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Asiedu A, Nelson AR, Gomez PP, Tappis H, Effah F, Allen C. "It builds your confidence… you've done well": Healthcare workers' experiences of participating in a low-dose, high-frequency training to improve newborn survival on the day of birth in Ghana. Gates Open Res 2019; 3:1470. [PMID: 31410394 PMCID: PMC6667826 DOI: 10.12688/gatesopenres.12936.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 12/04/2022] Open
Abstract
Background: The majority of newborn deaths occur during the first week of life, and 25‒45% occur within the first 24 hours. A low-dose, high-frequency (LDHF) training approach was introduced in 40 hospitals in Ghana to improve newborn survival. The aim of this qualitative study was to explore healthcare workers’ experiences with the LDHF approach to in-service training. Methods: A total of 20 in-depth interviews and nine focus group discussions were conducted in 2016 in three regions of Ghana with healthcare workers who participated in implementation of the LDHF training approach. In-depth interviews were conducted with 20 master mentors and peer practice coordinators; 51 practicing doctors, midwives and nurses participated in focus group discussions. Data were analyzed using a thematic analysis approach. Results: Healthcare workers reflected on the differences between the LDHF approach and past learning experiences, highlighting how the skills-based team training approach, coupled with high-frequency practice and mobile mentoring, built their competency and confidence. As participants shared their experiences, they highlighted relationships established between Master Mentors and healthcare workers, and motivation stemming from pride in contributing to reductions in maternal and newborn deaths as critical factors in improving quality of care at participating health facilities. Conclusion: This nested qualitative study documents experiences of healthcare workers and mentors involved in implementation of a multi-faceted intervention that effectively improved maternal and newborn care at health facilities in Ghana. The way the intervention was implemented created an environment conducive to learning within the hospital setting, thus providing an opportunity for professional growth and quality improvement for all staff working in the maternity ward.
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Williams E, Bazant ES, Holcombe S, Atukunda I, Namugerwa RI, Britt K, Evans C. "Practice so that the skill does not disappear": mixed methods evaluation of simulator-based learning for midwives in Uganda. HUMAN RESOURCES FOR HEALTH 2019; 17:24. [PMID: 30925890 PMCID: PMC6440002 DOI: 10.1186/s12960-019-0350-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 02/11/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Postpartum hemorrhage and neonatal asphyxia are leading causes of maternal and neonatal mortality, respectively, that occur relatively rarely in low-volume health facilities in sub-Saharan Africa. Rare occurrence of cases may limit the readiness and skills that individual birth attendants have to address complications. Evidence suggests that simulator-based training and practice sessions can help birth attendants maintain these life-saving skills; one approach is called "low-dose, high-frequency" (LDHF). The objective of this evaluation is to determine the facilitating factors and barriers to participation in LDHF practice, using qualitative and quantitative information. METHODS A trial in 125 facilities in Uganda compared three strategies of support for LDHF practice to improve retention of skills in prevention and treatment of postpartum hemorrhage and neonatal asphyxia. Birth attendants kept written logs of their simulator-based practice sessions, which were entered into a database, then analyzed using Stata to compare frequency of practice by the study arm. The evaluation also included 29 in-depth interviews and 19 focus group discussions with birth attendants and district trainers. Transcripts were entered in Atlas.ti software for coding, then analyzed using content analysis to identify factors that motivated or discouraged simulator-based practice. RESULTS Practice log data indicated that simulator-based practice sessions occurred more frequently in facilities where one or two practice coordinators helped schedule and lead the practice sessions and in health centers compared to hospitals. The qualitative data suggest that birth attendants who practiced more were motivated by a desire to maintain skills and be prepared for emergencies, external recognition, and establishing a set schedule. Barriers to consistent practice included low staffing levels, heavy workloads, and a sense that competency can be maintained through routine clinical care alone. Some facilities described norms around continuing education and some did not. CONCLUSIONS Designating practice coordinators to lead their peers in simulator-based practice led to more consistent skills practice within frontline health facilities. Ongoing support, scheduling of practice sessions, and assessment and communication of motivation factors may help sustain LDHF practice and similar forms of continuing professional development. TRIAL REGISTRATION Registered with clinicaltrials.gov #NCT03254628 on August 18, 2018 (registered retrospectively).
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Affiliation(s)
| | | | | | | | | | - Kayla Britt
- Jhpiego, 1615 Thames St, Baltimore, MD 21231 USA
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