Evaluation of neonatal resuscitation training in Lao P.D.R

Background Lao P.D.R. has the second highest neonatal mortality rate (83/1000) in Southeast Asia, but annual government health expenditures of only US$4 per capita. To help address pressing health disparities, the government pursues a policy of partnership formation to provide training to its health providers. In 2005, Deseret International Charities established a collaborative partnership with the Ministry of Health to provide neonatal resuscitation training, a proven method for reducing neonatal mortality. American experts trained 90 Lao physicians and midwives using the Neonatal Resuscitation Program (NRP) curriculum. These Lao trainers, from 15 of the 16 Lao provinces, participated in an intensive two-day NRP Instructor course and received equipment, teaching materials, and funding to instruct providers at their institutions. Design/Methods Eight months later two Lao physicians conducted an evaluation of the program. Surveys composed of structured and open-ended questions were mailed to the 90 trainers with 60 responses. Survey data described retention of training, degree of implementation of training, and effectiveness of training in reducing morbidity and mortality. On-site visits were conducted at six hospitals, where trainers were interviewed, tested on resuscitation knowledge, and given a skills test. Results/Outcome Combined data from surveys, interviews, and skills-testing showed 80% retention of knowledge and skills by the trainers. However, 50% indicated remaining insecurity and/or lack of opportunity to teach, with over 95% expressing a need for a refresher course. Only 10% of the trainers reported they had engaged in any teaching of others, and less than that reported conducting complete, formal training courses. While 10% reported specific cases of newborns having been saved as a result of training, hospital data on neonatal morbidity and mortality were unavailable or incomplete. Conclusions 1. Resuscitation trainers demonstrated retention of both knowledge and skills, but encountered obstacles to teaching, including insecurity as a trainer. 2. The quality of training decreased as the trainers returned and began teaching others at their institutions. 3. Deep training of a cadre of master trainers to assist the trainers might provide greater expertise, inspire greater confidence, and improve subsequent training.