Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

Robert B. Clark, MD, Department of Health Sciences, Brigham Young University, 221 Richards Building, Provo, UT 84602-2115, 801 423-2366, robclark@mstar.net

Background: Over 25% of neonatal deaths worldwide are attributed to birth asphyxia. This disproportionately affects the world's poorest countries. Enabling healthcare providers to effectively resuscitate infants is an established intervention for reducing the sequelae of asphyxia. The Neonatal Resuscitation Program (NRP) produced by the American Academy of Pediatrics (AAP) is an effective, skill-based tool for resuscitation training, but focuses on physicians in hospital settings. In contrast, community births (maternity homes, health centers, home deliveries), often occurring in resource-challenged areas, are the greatest contributors to the burden of poor newborn outcomes in sub-Saharan Africa and Southeast Asia.

Design/Methods: Permission was obtained from the AAP to modify the standard curriculum for community-based providers, including midwives. A consensus group of NRP Instructors developed a simplified version that included the principles, steps, and skills of the first three lessons. The core skills of rapid newborn evaluation and proper use of a bag and mask was emphasized by small-group drills. The content and tests were adapted to the local context with the preparation of simple handouts, flipcharts, and overheads. This simplified version was evaluated by 700 midwives and primary physicians in Ghana, Nigeria, Cambodia, and Laos. NRP-certified instructors conducted one to two-day train-the-trainer sessions, supplying these health care workers with bags and masks for delivery use, and manikins for further training dissemination. The learning transfer was assessed by participant observation, pre and post test score comparisons, and evaluation surveys.

Results/Outcome: Assimilation of resuscitation concepts, measured with pre/post test comparisons, demonstrated an average 35% improvement. Skill acquisition rating scores were “good” to “excellent” for 94% of the participants. Evaluation surveys revealed a strong acceptance of the training (96%) and its superiority over prior training (87%).

Conclusion: A simplified version of NRP was effective in teaching resuscitation to primary health care workers in resource-challenged locations. Providers acquired new knowledge and skills, demonstrated intent to apply new techniques, and were equipped with bags and masks for future deliveries. This simplified NRP curriculum may be appropriate for training midwives and other providers in similar community settings. Further research is needed to substantiate improved outcomes and long-term utilization.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• List the essential skills of basic neonatal resuscitation.
• Rethink the current strategies for delivering neonatal resuscitation training in resource-challenged areas.
• Understand the rationale, successes, and challenges in the application of a simplified Neonatal Resuscitation Program (NRP) curriculum.

Keywords: Infant Health, Birth Outcomes

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation