Influence of Neonatal Resuscitation Training on Practice of Community Health Extension Workers in Managing Asphyxiated Newborns in Rural Nigeria: A Qualitative Study

  • Global Pediatric Health, Volume 7, Year 2020

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Study Justification:
– Birth asphyxia is a global health burden, and effective neonatal resuscitation could reduce the burden of deaths.
– Providing suitable newborn resuscitation care depends on the availability of skilled health workers competent in neonatal resuscitation.
– This study explores and assesses the effect of neonatal resuscitation training and retention of knowledge and skills in managing asphyxiated newborns in rural Nigeria.
– Proficiency in neonatal resuscitation is essential for the survival of newborns and infants.
– Execution of a neonatal resuscitation training program in rural communities can further improve the knowledge and skills of community birth attendants in Nigeria.
Highlights:
– The study found a considerable retention of knowledge and ability to practice neonatal resuscitation procedures, even in the absence of some equipment.
– The qualitative research method used in this study allowed for accessing the thoughts and feelings of the research participants, providing an understanding of the meaning they ascribe to their experiences.
– The study participants were community health extension workers with extensive knowledge and experience in providing maternal and neonatal care at primary healthcare centers in Oyo State, Nigeria.
– The study used focused group discussions (FGDs) and in-depth interviews (IDIs) to collect data, which were then analyzed using a narrative analysis technique.
– Trustworthiness in qualitative research was achieved by adhering to established criteria during data collection and analysis, ensuring the truth value, applicability, consistency, and neutrality of the findings.
Recommendations:
– Implement a neonatal resuscitation training program in rural communities to improve the knowledge and skills of community birth attendants in managing asphyxiated newborns.
– Ensure the availability of necessary equipment for neonatal resuscitation in healthcare facilities.
– Conduct further research to assess the long-term impact of neonatal resuscitation training on reducing newborn mortality rates in rural Nigeria.
Key Role Players:
– Ministry of Health: Responsible for overseeing the implementation of the neonatal resuscitation training program and ensuring its integration into existing healthcare systems.
– Primary Healthcare Centers: Provide the infrastructure and resources for delivering neonatal resuscitation training and supporting community birth attendants in their practice.
– Community Health Extension Workers: Participate in the neonatal resuscitation training program and apply their knowledge and skills in managing asphyxiated newborns.
– Researchers and Educators: Develop and deliver the neonatal resuscitation training program, conduct research to evaluate its effectiveness, and provide ongoing education and support to community birth attendants.
Cost Items for Planning Recommendations:
– Training Materials: Development and production of training manuals, videos, and other educational resources.
– Training Sessions: Costs associated with organizing and conducting training sessions, including venue rental, facilitator fees, and participant allowances.
– Equipment and Supplies: Procurement and maintenance of necessary equipment for neonatal resuscitation, such as resuscitation masks, suction devices, and oxygen cylinders.
– Monitoring and Evaluation: Costs related to monitoring and evaluating the implementation and impact of the neonatal resuscitation training program, including data collection and analysis.
– Support and Supervision: Provision of ongoing support and supervision to community birth attendants, including mentorship and feedback mechanisms.
– Research and Evaluation: Funding for further research to assess the long-term impact of the neonatal resuscitation training program on newborn mortality rates in rural Nigeria.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study that used narrative analysis technique to analyze data from interviews. The study explored and assessed the effect of neonatal resuscitation training and retention of knowledge and skills in managing asphyxiated newborns in rural Nigeria. The study participants were community health extension workers working in primary health centers in selected local government associations. The qualitative method used in data collection included focused group discussions and in-depth interviews. The study achieved trustworthiness by following established criteria for data collection and analysis. However, the abstract does not provide information on the sample size or the specific findings of the study. To improve the evidence, the abstract could include more details on the sample size, specific findings, and implications of the study’s results.

Birth asphyxia is a global health burden, and effective neonatal resuscitation could reduce the burden of deaths. Providing a suitable newborn resuscitation care will depend on the availability of an effective skilled health worker, who is competent in neonatal resuscitation. The study explores and assesses the effect of neonatal resuscitation training and retention of knowledge and skills in the management of asphyxiated newborns in rural Nigeria. This study used a narrative analysis technique to analyze data from a semistructured, individual interview. Data were analyzed using ATLAS.ti 8 qualitative software and applying the principle of thematic analysis. There was a considerable retention of knowledge and ability to practice the procedure even though some equipment was not available. Proficiency in neonatal resuscitation is an essential intervention for the survival of newborns and infants. Therefore, execution of neonatal resuscitation training program in rural communities can further improve knowledge and skills of community birth attendants in Nigeria.

This qualitative study was part of a larger study toward testing and refining a NR training model for semiskilled birth attendants. The qualitative method used in data collection was focused group discussions (FGDs) and in-depth interviews (IDIs) with participants. Each interview was moderated by the researcher; this was to ensure that the technicalities of the study were not misplaced or misinterpreted. The data were analyzed using a narrative analysis technique. This technique is similar to Constant Comparison analysis technique.21 This method gives a systematic and creative process for analyzing data. The narrative technique was decided to be best suited for this study because of the nature and the purpose of the qualitative data. Codes were generated and themes developed. These themes were partly created following the objectives. There were 3 major themes in this study. These themes were developed through an inductive and deductive process. This research was conducted at PHCs in Oyo State of Nigeria. The study participants were the community health extension workers working in 54 PHCs in selected local government associations. Respondents for FGDs and IDIs were purposively selected from the quantitative sample, that is, those who participate in NR training. The community health workers selected were those with extensive knowledge and experience in providing maternal and neonatal care at the PHC based on their years of experience. Fifteen participants were selected for FGD, with 2 groups of 8 and 7 participants, while 10 participants were selected for IDI. Data were collected by the researcher (AAO) in Yoruba (local language) as preferred by participants. A semistructured interview guide was adopted and used for each participant.22 Qualitative research helps researchers access the thoughts and feelings of research participants, which can enable the development of an understanding of the meaning that people ascribe to their experiences. In this study, face-to-face interviews, through FGDs and IDIs, were used to explore research phenomenon and help in clarifying less-well-understood problems and situations. These tools were selected because they aligned with pragmatism paradigm. During the interviews, participants were so excited, and this was demonstrated throughout the period. The interview lasted 50 to 90 minutes and was audio-tape recorded with participant approval. Because they were semiskilled birth attendants working in the community, they were comfortable with “Yoruba” indigenous language; therefore, all interviews were conducted in “Yoruba” language. All interviews were translated into English language, and transcription was done verbatim at the end of each day. The interview transcripts were read line by line several times, to achieve data immersion while reflecting on the data analysis. ATLAS.ti, a qualitative software, was used to manage the data. Trustworthiness in qualitative research is achieved by establishing adherence to a number of criteria during data collection and analysis to ensure truth value, applicability, consistency, and neutrality of the findings. This study achieved trustworthiness by obediently following the established criteria during data collection and analysis, to guarantee significant reality, uniformity, and objectivity of the findings. The trustworthiness of this study was established with reference to Guba’s 4 proposed criteria of Credibility, Transferability, Dependability, and Confirmability.23 The study was approved by the Biomedical Research Ethics Committee of the University of Kwazulu-Natal, Durban, South Africa (BE391/18), and Oyo State Ministry of Health Research Ethical Committee, Nigeria. All participants provide a written informed consent prior to participation in the study.

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Based on the provided description, the following innovations could potentially improve access to maternal health:

1. Neonatal Resuscitation Training: Implementing a comprehensive and standardized neonatal resuscitation training program for community health extension workers in rural areas of Nigeria. This would ensure that skilled health workers are equipped with the necessary knowledge and skills to effectively manage asphyxiated newborns.

2. Retention of Knowledge and Skills: Developing strategies to enhance the retention of knowledge and skills acquired through neonatal resuscitation training. This could include regular refresher courses, ongoing mentorship, and supportive supervision to ensure that community health workers maintain their proficiency in neonatal resuscitation.

3. Availability of Equipment: Addressing the issue of limited availability of equipment for neonatal resuscitation in rural areas. This could involve improving the supply chain management system to ensure a consistent and adequate supply of essential resuscitation equipment, such as bag-valve masks and suction devices, to health facilities in remote areas.

4. Community Birth Attendants: Strengthening the knowledge and skills of community birth attendants in maternal and neonatal care. This could be achieved through targeted training programs and capacity-building initiatives that focus on improving the quality of care provided by community health workers during childbirth and the immediate postpartum period.

5. Language Accessibility: Ensuring that training materials and communication with community health workers are available in local languages, such as Yoruba, to facilitate better understanding and engagement during training sessions and interviews.

6. Qualitative Research: Conducting qualitative research, such as focused group discussions and in-depth interviews, to gain insights into the experiences and perspectives of community health workers. This can help identify barriers and facilitators to the implementation of neonatal resuscitation training programs and inform the development of context-specific interventions.

It is important to note that these recommendations are based on the information provided and may need to be further explored and adapted to the specific context and needs of rural Nigeria.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health based on the described study is the execution of a neonatal resuscitation training program in rural communities in Nigeria. The study found that there was a considerable retention of knowledge and ability to practice neonatal resuscitation procedures among community health extension workers, despite the lack of some equipment.

By implementing a neonatal resuscitation training program in rural communities, the knowledge and skills of community birth attendants can be further improved. This intervention is crucial for the survival of newborns and infants. The training program can be designed to target semiskilled birth attendants and provide them with the necessary skills and knowledge to effectively manage asphyxiated newborns.

To ensure the success of the training program, it is important to use qualitative research methods such as focused group discussions (FGDs) and in-depth interviews (IDIs) to understand the thoughts and feelings of the participants. Conducting the interviews in the local language, such as Yoruba in this case, can help participants feel more comfortable and open during the interviews.

To establish trustworthiness in the qualitative research, adherence to criteria such as credibility, transferability, dependability, and confirmability should be followed. This includes obtaining ethical approval from relevant research ethics committees and obtaining written informed consent from all participants.

Overall, implementing a neonatal resuscitation training program in rural communities in Nigeria can be a valuable innovation to improve access to maternal health and reduce the burden of birth asphyxia.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Implement a comprehensive neonatal resuscitation training program: This recommendation suggests the development and implementation of a training program focused on neonatal resuscitation for healthcare workers, particularly those in rural areas. The program should aim to improve knowledge and skills in managing asphyxiated newborns, ultimately reducing neonatal mortality rates.

2. Strengthen healthcare infrastructure: To improve access to maternal health, it is crucial to strengthen healthcare infrastructure in rural areas. This includes ensuring the availability of necessary equipment and supplies for neonatal resuscitation, as well as improving the overall quality and accessibility of healthcare facilities.

3. Increase community awareness and engagement: Enhancing community awareness and engagement is essential for improving access to maternal health. This can be achieved through community education programs, outreach initiatives, and the involvement of community leaders and stakeholders in promoting maternal health services.

Methodology to simulate the impact of these recommendations on improving access to maternal health:

1. Define the target population: Identify the specific population that will be impacted by the recommendations, such as community health extension workers in rural Nigeria.

2. Collect baseline data: Gather data on the current knowledge, skills, and practices of the target population related to neonatal resuscitation and maternal health. This can be done through surveys, interviews, or focus group discussions.

3. Develop a simulation model: Create a simulation model that incorporates the recommended interventions, such as the neonatal resuscitation training program, strengthening healthcare infrastructure, and community awareness initiatives. The model should consider factors such as population size, healthcare resources, and community engagement.

4. Input data and parameters: Input the collected baseline data into the simulation model, along with relevant parameters such as training effectiveness, availability of equipment, and community participation rates.

5. Run simulations: Run multiple simulations using the model to simulate the impact of the recommendations on improving access to maternal health. This can include measuring outcomes such as changes in knowledge and skills, reduction in neonatal mortality rates, and improvements in healthcare infrastructure.

6. Analyze results: Analyze the results of the simulations to assess the potential impact of the recommendations. This can involve comparing the baseline data with the simulated outcomes to determine the effectiveness of the interventions.

7. Refine and iterate: Based on the analysis of the simulation results, refine the recommendations and simulation model as needed. Iterate the process by collecting additional data and running simulations to further evaluate the impact of the interventions.

By following this methodology, researchers and policymakers can gain insights into the potential impact of the recommended interventions on improving access to maternal health and make informed decisions on implementing these innovations.


Identifiers:
DOI: 10.1177/2333794X20938944
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Social Determinants, Workforce
Study Countries:
Multi-Countries, Nigeria, South Africa
Study Design:
Exploratory Study, Grounded Theory, Narrative Study, Phenomenological Study, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative
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