Intervention Improved Health Workers' Neonatal Resuscitation Skills and Knowledge, but Not Neonatal Mortality

Abstract

Health care workers who participated in a mobile phone-based safe delivery intervention had greater skills and knowledge regarding neonatal resuscitation than control workers, according to a cluster-randomized clinical trial conducted at 70 health care facilities in rural Ethiopia. (1) Neonatal resuscitation skills scores six months and 12 months after implementation of the safe delivery app intervention were higher among intervention health care workers than among controls (mean differences, 6.0 and 8.8 points, respectively); neonatal resuscitation knowledge was higher among intervention health care workers than among controls at six months postimplementation (mean difference, 1.7 points), but not at 12 months. The intervention was not associated with a significant change in perinatal mortality of infants delivered at study health care facilities. The safe delivery app was designed to provide health care workers in low-income countries with the knowledge and skills to manage obstetric and neonatal emergencies; the app consisted of videos on topics such as neonatal resuscitation, as well as a catalog of essential obstetric drugs and equipment. To examine whether use of the app was associated with changes in perinatal mortality rates and in health care workers' knowledge and skill levels, researchers conducted a cluster-randomized clinical trial of health care facilities in five rural districts of Ethiopia's Oromiya region. Of the 131 facilities that were screened, 70 met the study's eligibility criteria (i.e., having a midwife or health extension worker on staff and having been the site of deliveries in the previous year) and were included in the study sample. Half of eligible facilities were randomly selected to the intervention group and were supplied with smartphones loaded with the safe delivery app; health care workers at intervention facilities received a one-day training session on how to use the phones and app. The other half of facilities were selected to the control group, and did not receive phones or additional training; the researchers ensured that both intervention and control facilities had an adequate package of drugs and equipment. Between September 2013 and February 2015, data were collected on women delivering at study facilities and on their birth outcomes; women were contacted in person or by phone seven days after delivery to follow up about perinatal mortality. In addition, facility health care workers' knowledge and skills regarding neonatal resuscitation were assessed by questionnaire and structured assessment tools (e.g., simulated scenarios using mannequins) before implementation of the intervention and at six and 12 months afterward. Descriptive and logistic regression analyses were used to compare perinatal mortality rates at intervention and control facilities, and to compare health care workers' neonatal resuscitation knowledge and skills index scores over time. The analysis sample included 1,474 women in the intervention group and 1,665 in the control group. Most women in each group (>85%) reported being younger than 29, having a primary or lower education and being a housewife; more than one-third of women in each group were pregnant for the first time. …