TY - JOUR
T1 - Assessing the capacity for newborn resuscitation and factors associated with providers' knowledge and skills
T2 - A cross-sectional study in Afghanistan
AU - Kim, Young Mi
AU - Ansari, Nasratullah
AU - Kols, Adrienne
AU - Tappis, Hannah
AU - Currie, Sheena
AU - Zainullah, Partamin
AU - Bailey, Patricia
AU - Semba, Richard
AU - Sun, Kai
AU - van Roosmalen, Jos
AU - Stekelenburg, Jelle
N1 - Funding Information:
The authors would like to thank UNICEF for funding the study and technical collaboration, the central and provincial offices of the Afghanistan Ministry of Public Health (MoPH) for their guidance and support, and the many health professionals who participated in the study. The authors would also like to thank all of the midwives and doctors who served as data collectors in very difficult situations, as well as the nongovernmental organization staff implementing Afghanistan’s Basic Package of Health Services. Finally, the authors would like to acknowledge the support of Malali Naziri from UNICEF; Sadia Ayubi from MoPH; Denise Byrd, Manizha Faqir, Mohammed Masood Arzoly, Khalid Yari, Liza Hashemi, Zahera Sediqqi, Matiullah Noorzad, Abdul Qader Rahimi, Adela Kohistani, Rahela Joya, Akmal Samsor and Humaira Alawi from Jhpiego/Afghanistan; and Jaime Mungia, Harshad Sanghvi, Patricia Gomez, Eva Bazant and Sue Tredwell from Jhpiego/Baltimore.
PY - 2013/9/10
Y1 - 2013/9/10
N2 - Background: Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in resource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering comprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility characteristics associated with providers' knowledge and clinical skills.Methods: Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn resuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and infrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses were performed using STATA 11.2 and SAS 9.1.3.Results: Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag, and mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely than doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No significant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in performing newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge questions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in their ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and clinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience offering EmONC services.Conclusions: Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan, but providers' knowledge and skills need strengthening in some areas. Midwives proved to be as capable as doctors of performing newborn resuscitation, which validates the major investment made in midwifery education. Competency-based pre-service and in-service training, complemented by supportive supervision, is an effective way to build providers' capacity to perform newborn resuscitation. This kind of training could also help skilled birth attendants based in the community, at private clinics, or at primary care facilities save the lives of newborns.
AB - Background: Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in resource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering comprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility characteristics associated with providers' knowledge and clinical skills.Methods: Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn resuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and infrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses were performed using STATA 11.2 and SAS 9.1.3.Results: Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag, and mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely than doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No significant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in performing newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge questions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in their ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and clinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience offering EmONC services.Conclusions: Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan, but providers' knowledge and skills need strengthening in some areas. Midwives proved to be as capable as doctors of performing newborn resuscitation, which validates the major investment made in midwifery education. Competency-based pre-service and in-service training, complemented by supportive supervision, is an effective way to build providers' capacity to perform newborn resuscitation. This kind of training could also help skilled birth attendants based in the community, at private clinics, or at primary care facilities save the lives of newborns.
KW - Afghanistan
KW - Birth asphyxia
KW - Emergency obstetric care
KW - Intrapartum hypoxia
KW - Lower income countries
KW - Neonatal mortality
KW - Newborn resuscitation
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U2 - 10.1186/1471-2431-13-140
DO - 10.1186/1471-2431-13-140
M3 - Article
C2 - 24020392
AN - SCOPUS:84883639061
SN - 1471-2431
VL - 13
JO - BMC Pediatrics
JF - BMC Pediatrics
IS - 1
M1 - 140
ER -