Assessing the capacity for newborn resuscitation and factors associated with providers' knowledge and skills: A cross-sectional study in Afghanistan

Young Mi Kim, Nasratullah Ansari, Adrienne Kols, Hannah Tappis, Sheena Currie, Partamin Zainullah, Patricia Bailey, Richard Semba, Kai Sun, Jos van Roosmalen, Jelle Stekelenburg

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Article number140
JournalBMC Pediatrics
Issue number1
StatePublished - Sep 10 2013


  • Afghanistan
  • Birth asphyxia
  • Emergency obstetric care
  • Intrapartum hypoxia
  • Lower income countries
  • Neonatal mortality
  • Newborn resuscitation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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