Standard basic emergency obstetric and neonatal care training in Addis Ababa; Trainees reaction and knowledge acquisition

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Study Justification:
– The study aims to evaluate the effectiveness of the standard Basic Emergency Obstetric and Neonatal Care (BEmONC) training curricula in Addis Ababa, Ethiopia.
– The training curricula were developed in response to the high demand for competency in EmONC, but their effectiveness has not been well documented.
– The study is part of a collaborative intervention project to improve the quality of basic EmONC in Addis Ababa and ensure equitable access.
Highlights:
– The study evaluated the knowledge acquisition of providers who received the standard BEmONC training.
– The training included intensive hands-on skills training using low-cost and low-tech simulators.
– Pre-course assessments were conducted to identify knowledge gaps among trainees.
– Immediate post-course evaluations were used to assess knowledge-based mastery.
– A six-month post-training evaluation was conducted to assess knowledge retention.
– Trainees were also asked to evaluate the course in various areas, such as appropriateness, training facilities, facilitators, and teaching aids.
Recommendations:
– The study highlights the importance of standard BEmONC training in improving the quality of maternal and neonatal care.
– It recommends the continued implementation of the training curricula to ensure competency among providers.
– The study suggests regular evaluations of knowledge acquisition and retention to identify areas for improvement.
– It emphasizes the importance of hands-on skills training and the use of low-cost simulators.
– The study recommends ongoing support and supervision for providers to maintain and enhance their skills.
Key Role Players:
– Federal Ministry of Health of Ethiopia (FMOH)
– Addis Ababa City Administration Health Bureau
– Ethiopian Midwifery Association
– Project leader and project team members
– Health bureaus of the 10 sub-cities in Addis Ababa
– Ethical committees (Addis Ababa City Administration Health Bureau Ethics Committee and regional Ethics committee in West Norway)
Cost Items for Planning Recommendations:
– Training materials and resources
– Simulators (MamNatalie and NeoNatalie)
– Venue and facilities for training
– Trainers’ fees and travel expenses
– Evaluation tools and data collection
– Support and supervision for providers
– Administrative and logistical support

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides a detailed description of the training program and evaluation methods. It also mentions ethical approval and study permits obtained. However, the abstract does not provide specific results or statistical analysis. To improve the evidence, the abstract should include the findings of the evaluation, such as the percentage of trainees who achieved knowledge-based mastery and the results of the trainees’ evaluation of the course. Additionally, including any statistical analysis or significance tests would further strengthen the evidence.

Background: In 2010, the Federal Ministry of Health of Ethiopia (FMOH) has developed standard Basic Emergency Obstetric and Neonatal Care (BEmONC) in-service training curricula to respond to the high demand for competency in EmONC. However, the effectiveness of the training curricula has not been well documented. A collaborative intervention project in Addis Ababa has trained providers using the standard BEmONC curricula where this paper presents Krikpartick level 1 and level 2 evaluation of the training.

Addis Ababa, the capital of Ethiopia is administratively divided into 10 sub-cities. Of the over 3.5 million people living in the city, about 70% are mothers and children. Over 70 public HCs and five public hospitals under the Addis Ababa City Administration Health Bureau are offering maternal and child health care to the majority of the city dwellers. All the public HCs are primary care units and are the first contact point in the continuum of maternal and newborn health care. These HCs are also providing BEmONC, while all the public hospitals provide comprehensive EmONC. A referral network has established from the public HCs to the hospitals for mothers and babies who are requiring advanced interventions. This study was part of the collaborative intervention project in Addis Ababa. The project has got ethical approval from the Addis Ababa City Administration Health Bureau Ethics Committee and by the regional Ethics committee in West Norway. Study permits were obtained from the Addis Ababa City Administration Health Burea, the health bureaus of the 10 sub-cities and from the project HCs. The main objective of the project is to improve the quality of basic EmONC in Addis Ababa and to ensure equitable access. For improving quality, intensive hands on skills training using low cost and low tech simulators (MamNatalie and NeoNatalie) were provided. For bridging the equity gaps, the project targeted public HC where the majority of poor and disadvantaged women are accessing EmONC services. Of the 24 HC providing delivery care services in the city, ten HC one from each sub city was randomly selected for the project. There were 89 midwives and nurses who were working in the delivery wards of the project HCs. Of these eligible providers, seven did not receive the training (One for social reason while the rest had already received the training recently). Eighty two providers received the standard BEmONC training in four rounds where each round of the training took three weeks in accordance with the standard set by the FMOH [9] (Figure 1). The Ethiopian Midwifery Association having vast experiences in implementing the standard BEmONC training across the country conducted the training under close supervision of the project leader and project team members. Study flow chart. The first eight days of the training were classroom theoretical sessions complemented with demonstration, videos, case studies and role plays. The last ten days were for the skills training using demonstrations and clinical sessions until trainees achieve mastery in selected skills with checklist based evaluations. Prior to the start of the course, pre-course assessment was done to identify knowledge gaps among trainees on the management of shock, bleeding before and after birth, normal labour, third stage of labour, pre-eclampsia/eclampsia, partograph use, puerperal sepsis and on neonatal resuscitation. By the end of the theoretical sessions, there was an immediate post-course evaluation to assess knowledge-based mastery using a tool that contained 36 multiple-choice questions on nine major topics; 1) infection prevention practices, 2) vaginal bleeding in early pregnancy, 3) rapid initial assessment and management of shock, 4) childbirth care, 5) unsatisfactory progress of labour, 6) mal-presentation and malposition, 6) headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure, 7) vaginal bleeding after child birth, 8) fever and 9) new born care. Trainees who answered 31 questions correctly out of the 36 or those who scored ≥85% were considered to have achieved knowledge-based mastery according to the standard BEmONC training curriculum [9]. Trainees who failed to achieve knowledge-based mastery in the first attempt sat for re-exam until they recorded mastery. However, this paper presents the knowledge-based mastery recorded in their first attempt. Six-month post training 74 (90.2%) providers participated in a knowledge retention evaluation (Figure 1). All the providers were approached in their respective workplace to fill out the same tool that was used to assess the knowledge-based mastery during the immediate post-course. The aim of this evaluation was to assess knowledge retention six months after the training. By the end of the third week of the training, trainees were asked to evaluate the course in eight major areas in a scale ranging from strongly disagree to strongly agree. Assessed topics included 1) For the work I do, the training was appropriate 2) Training facilities & arrangements were satisfactory 3) The facilitators were knowledgeable & skilled 4) The facilitators were fair and friendly 5) Training objectives were met 6) The training was updating my knowledge & skills 7) Teaching aids were useful and 8) Practice in the clinical areas was important & helpful. The findings are presented in percentages, mean, standard deviation and student t-tests.

Based on the provided description, here are some potential innovations that could be recommended to improve access to maternal health:

1. Mobile Health Clinics: Implementing mobile health clinics equipped with basic emergency obstetric and neonatal care facilities can help reach remote areas and provide essential maternal health services to underserved populations.

2. Telemedicine: Introducing telemedicine services can enable healthcare providers to remotely assess and monitor pregnant women, provide medical advice, and facilitate timely referrals to higher-level healthcare facilities when necessary.

3. Community Health Workers: Training and deploying community health workers who can provide basic maternal health services, educate pregnant women on prenatal care, and conduct home visits to monitor the health of mothers and newborns can improve access to care, especially in rural areas.

4. Public-Private Partnerships: Collaborating with private healthcare providers to expand access to maternal health services can help alleviate the burden on public healthcare facilities and ensure that more women have access to quality care.

5. Health Information Systems: Implementing robust health information systems can improve data collection, monitoring, and evaluation of maternal health services, enabling policymakers to make informed decisions and allocate resources effectively.

6. Financial Incentives: Introducing financial incentives, such as conditional cash transfers or subsidies, for pregnant women seeking antenatal care, skilled birth attendance, and postnatal care can encourage more women to utilize these services and improve access to maternal health.

7. Maternal Health Education Programs: Developing and implementing comprehensive maternal health education programs that target women, families, and communities can increase awareness about the importance of maternal health and promote healthy behaviors during pregnancy.

8. Strengthening Referral Systems: Enhancing the existing referral network between primary healthcare centers and hospitals by improving communication, transportation, and coordination can ensure timely access to emergency obstetric and neonatal care for high-risk pregnancies.

These innovations, if implemented effectively, can contribute to improving access to maternal health services and ultimately reduce maternal and neonatal mortality rates.
AI Innovations Description
Based on the provided description, the recommendation to improve access to maternal health would be to continue implementing the standard Basic Emergency Obstetric and Neonatal Care (BEmONC) training curricula in Addis Ababa. This training has been shown to be effective in improving the quality of basic EmONC and ensuring equitable access to maternal and newborn health care.

To further enhance the impact of the training, the following suggestions can be considered:

1. Continuous Monitoring and Evaluation: Regular monitoring and evaluation of the training program should be conducted to assess its effectiveness and identify areas for improvement. This will help ensure that the training is meeting its objectives and addressing the specific needs of the trainees.

2. Strengthening Referral Systems: While the training focuses on basic EmONC, it is important to strengthen the referral systems from primary care units (public HCs) to comprehensive EmONC facilities (public hospitals). This will ensure that mothers and babies who require advanced interventions can access them in a timely manner.

3. Integration of Low-Cost Simulators: The use of low-cost and low-tech simulators, such as MamNatalie and NeoNatalie, has been proven to be effective in providing hands-on skills training. These simulators should continue to be integrated into the training program to enhance the practical skills of the trainees.

4. Knowledge Retention and Continuous Learning: Follow-up evaluations, such as the six-month post-training knowledge retention evaluation, should be conducted to assess the long-term impact of the training. Continuous learning opportunities, such as refresher courses or online resources, should also be provided to ensure that the trainees stay updated on the latest practices and guidelines.

5. Trainee Feedback and Satisfaction: The trainees’ feedback and satisfaction with the training program should be regularly collected and analyzed. This will help identify areas of improvement and ensure that the training meets the needs and expectations of the trainees.

By implementing these recommendations, the standard BEmONC training program can be further developed into an innovation that improves access to maternal health in Addis Ababa.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Strengthening referral networks: Enhance the existing referral network between public health centers and hospitals to ensure timely and efficient transfer of mothers and babies requiring advanced interventions.

2. Community-based interventions: Implement community-based programs to raise awareness about maternal health, provide education on pregnancy and childbirth, and promote the utilization of maternal health services.

3. Mobile health (mHealth) solutions: Utilize mobile technology to provide remote access to maternal health information, appointment reminders, and teleconsultations with healthcare providers.

4. Task-shifting and training: Train and empower community health workers and midwives to provide basic maternal health services, including antenatal care, delivery assistance, and postnatal care, in underserved areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the number of maternal deaths, the percentage of women receiving antenatal care, and the percentage of deliveries attended by skilled birth attendants.

2. Data collection: Gather baseline data on the selected indicators before implementing the recommendations. This can be done through surveys, interviews, and analysis of existing health records.

3. Implement the recommendations: Roll out the recommended interventions in the target areas, ensuring proper training, infrastructure, and resources are in place.

4. Data analysis: Collect data on the selected indicators after the implementation of the recommendations. Compare the post-intervention data with the baseline data to assess the impact of the interventions.

5. Evaluate outcomes: Analyze the data to determine the extent to which the recommendations have improved access to maternal health. This can involve statistical analysis, such as calculating percentages, means, and standard deviations, as well as conducting t-tests to compare pre- and post-intervention data.

6. Interpret and report findings: Summarize the findings of the impact assessment, highlighting the changes observed in the selected indicators. Provide recommendations for further improvement based on the results.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and assess the effectiveness of the interventions implemented.

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