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Nkya S, Mtei L, Soka D, Mdai V, Mwakale PB, Mrosso P, Mchoropa I, Rwezaula S, Azayo M, Ulenga N, Ngido M, Cox SE, D'Mello BS, Masanja H, Kabadi GS, Mbuya F, Mmbando B, Daniel Y, Streetly A, Killewo J, Tluway F, Lyimo M, Makani J. Newborn screening for sickle cell disease: an innovative pilot program to improve child survival in Dar es Salaam, Tanzania. Int Health 2020; 11:589-595. [PMID: 31145786 DOI: 10.1093/inthealth/ihz028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 02/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a recognized cause of childhood mortality. Tanzania has the fifth highest incidence of SCD (with an estimated 11 000 SCD annual births) worldwide. Although newborn screening (NBS) for SCD and comprehensive healthcare have been shown to reduce under-5 mortality by up to 94% in high-income countries such as the USA, no country in Africa has maintained NBS for SCD as a national health program. The aims of this program were to establish and evaluate NBS-SCD as a health intervention in Tanzania and to determine the birth prevalence of SCD. METHODS Muhimbili University of Health and Allied Sciences conducted NBS for SCD from January 2015 to November 2016. Dried blood spot samples were collected and tested for SCD using isoelectric focusing. RESULTS Screening was conducted on 3981 newborns. Thirty-one (0.8%) babies had SCD, 505 (12.6%) had sickle cell trait and 26 (0.7%) had other hemoglobinopathies. Twenty-eight (90.3%) of the 31 newborns with SCD were enrolled for comprehensive healthcare. CONCLUSIONS This is the first report on NBS as a health program for SCD in Tanzania. The SCD birth prevalence of 8 per 1000 births is of public health significance. It is therefore important to conduct NBS for SCD with enrollment into a comprehensive care program.
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Affiliation(s)
- Siana Nkya
- Dar es Salaam University College of Education, Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lillian Mtei
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deogratias Soka
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vera Mdai
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Promise B Mwakale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Mrosso
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Issa Mchoropa
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Delloite and Touche, Dar es Salaam, Tanzania
| | - Stella Rwezaula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Melkiory Ngido
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Delloite and Touche, Dar es Salaam, Tanzania
| | - Sharon E Cox
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Graduate School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan.,Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Brenda S D'Mello
- Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), Dar es Salaam, Tanzania
| | | | - Gregory S Kabadi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Frederick Mbuya
- Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Mmbando
- Dar es Salaam University College of Education, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Yvonne Daniel
- Public Health England, NHS Sickle Cell and Thalassemia Screening Programme and National Healthcare Public Health Division, London, UK
| | - Allison Streetly
- Public Health England, NHS Sickle Cell and Thalassemia Screening Programme and National Healthcare Public Health Division, London, UK
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Furahini Tluway
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Magdalena Lyimo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,National Blood Transfusion service, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Drake M, Bishanga DR, Temu A, Njozi M, Thomas E, Mponzi V, Arlington L, Msemo G, Azayo M, Kairuki A, Meda AR, Isangula KG, Nelson BD. Structured on-the-job training to improve retention of newborn resuscitation skills: a national cohort Helping Babies Breathe study in Tanzania. BMC Pediatr 2019; 19:51. [PMID: 30732580 PMCID: PMC6366017 DOI: 10.1186/s12887-019-1419-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Newborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Improving provider newborn resuscitation skills is critical for delivering quality care, but the retention of these skills has been a challenge. Tanzania implemented a national newborn resuscitation using the Helping Babies Breathe (HBB) training program to help address this problem. Our objective was to evaluate the effectiveness of two training approaches to newborn resuscitation skills retention implemented across 16 regions of Tanzania. Methods An initial training approach implemented included verbal instructions for participating providers to replicate the training back at their service delivery site to others who were not trained. After a noted drop in skills, the program developed structured on-the-job training guidance and included this in the training. The approaches were implemented sequentially in 8 regions each with nurses/ midwives, other clinicians and medical attendants who had not received HBB training before. Newborn resuscitation skills were assessed immediately after training and 4–6 weeks after training using a validated objective structured clinical examination, and retention, measured through degree of skills drop, was compared between the two training approaches. Results Eight thousand, three hundred and ninety-one providers were trained and assessed: 3592 underwent the initial training approach and 4799 underwent the modified approach. Immediately post-training, average skills scores were similar between initial and modified training groups: 80.5 and 81.3%, respectively (p-value 0.07). Both groups experienced statistically significant drops in newborn resuscitation skills over time. However, the modified training approach was associated with significantly higher skills scores 4–6 weeks post training: 77.6% among the modified training approach versus 70.7% among the initial training approach (p-value < 0.0001). Medical attendant cadre showed the greatest skills retention. Conclusions A modified training approach consisting of structured OJT, guidance and tools improved newborn resuscitation skills retention among health care providers. The study results give evidence for including on-site training as part of efforts to improve provider performance and strengthen quality of care. Electronic supplementary material The online version of this article (10.1186/s12887-019-1419-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary Drake
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania. .,University of Groningen, University Medical Centre Groningen, Department of Health Sciences, GlobalHealth, Groningen, the Netherlands.
| | - Dunstan R Bishanga
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania.,University of Groningen, University Medical Centre Groningen, Department of Health Sciences, GlobalHealth, Groningen, the Netherlands
| | - Akwila Temu
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Mustafa Njozi
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Erica Thomas
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Victor Mponzi
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Lauren Arlington
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Georgina Msemo
- Ministry of Health and Social Welfare, 36/37 Samora Avenue, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health and Social Welfare, 36/37 Samora Avenue, Dar es Salaam, Tanzania
| | - Allan Kairuki
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Amunga R Meda
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Kahabi G Isangula
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Brett D Nelson
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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3
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Muhe LM, Iriya N, Bundala F, Azayo M, Bakari MJ, Hussein A, John T. Evaluation of distance learning IMCI training program: the case of Tanzania. BMC Health Serv Res 2018; 18:547. [PMID: 30001709 PMCID: PMC6044076 DOI: 10.1186/s12913-018-3336-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The standard 11-days IMCI (Integrated Management of Childhood Illness) training course (standard IMCI) has faced barriers such as high cost to scale up. Distance learning IMCI training program was developed as an alternative to the standard IMCI course. This article presents the evaluation results of the implementation of distance learning IMCI training program in Tanzania. METHODS From December 2012 to end of June 2015, a total of 4806 health care providers (HCP) were trained on distance learning IMCI from 1427 health facilities {HF) in 68 districts in Tanzania. Clinical assessments were done at the end of each course and on follow up visits of health facilities 4 to 6 weeks after training. The results of those assessments are used to compare performance of health care providers trained in distance learning IMCI with those trained in the standard IMCI course. Statistical analysis is done by comparing proportions of those with appropriate performances using four WHO priority performance indicators as well as cost of conducting the courses. In addition, the perspectives of health care providers, IMCI course facilitators, policy makers and partners were gathered using either focussed group discussions or structured questionnaires. RESULTS Distance learning IMCI allowed clusters of training courses to take place in parallel, allowing rapid expansion of IMCI coverage. Health care providers trained in distance learning IMCI performed equally well as those trained in the standard IMCI course in assessing Main Symptoms, treating sick children and counselling caretakers appropriately. They performed better in assessing Danger Signs. Distance learning IMCI gave a 70% reduction in cost of conducting the training courses. CONCLUSION Distance learning IMCI is an alternative to scaling up IMCI as it provides an effective option with significant cost reduction in conducting training courses.
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Affiliation(s)
- Lulu M Muhe
- Department of Pediatrics and Child Health, Addis Ababa University, P.O.Box 1768, Addis Ababa, Ethiopia.
| | - Nemes Iriya
- Child and Adolescent Health, World Health Organization Country Office, Dar Es Salaam, Tanzania
| | | | - Mary Azayo
- UNICEF Country Office, Dar Es Salaam, Tanzania
| | | | | | - Theopista John
- Child and Adolescent Health, World Health Organization Country Office, Dar Es Salaam, Tanzania
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Isangula KG, Kassick ME, Kairuki AK, Meda RA, Thomas E, Temu A, Msemo G, Azayo M, Nelson BD. Provider experiences with the large-scale 'Helping Babies Breathe' training programme in Tanzania. Paediatr Int Child Health 2018; 38:46-52. [PMID: 27682965 DOI: 10.1080/20469047.2016.1219119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Worldwide, there has been renewed emphasis on reducing neonatal mortality in low-resource countries. The Helping Babies Breathe (HBB) programme has been shown to reduce newborn deaths. The aim of this study is to present provider-level perceptions and experiences of the HBB programme implemented at-scale in Tanzania and identify key lessons learned for scalability in similar and other settings. METHODS Focus group discussions with HBB-trained providers were conducted using a prospective longitudinal study design between October 2013 and May 2015. A semi-structured discussion guide was used to facilitate the focus groups which were held 4-6 weeks and 4-6 months post-HBB training. Data were managed using NVivo software and analysed thematically. RESULTS A total of 222 focus group discussions were conducted in 252 trained facilities and involved 599 providers across 15 regions of Tanzania. Birth attendants reported that the training programme helped increase knowledge, skills and confidence, and that the provided equipment simplified resuscitation. Supportive supervision and regular follow-up visits were considered critical for skills retention. On the other hand, the brief 1-day training in Tanzania, small financal incentives, intra-facility rotations of trained attendants, staff shortages, limited rescucitation spaces and mastery of the bag-and-mask were considered challenges to the HBB programme in Tanzania. DISCUSSION The HBB programme was largely very well received during its first at-scale implementation in Tanzania. Addressing the main challenges cited by participants, particularly the training duration, may increase provider satisfaction with the HBB training programme.
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Affiliation(s)
- Kahabi Ganka Isangula
- a Division of Global Health, Department of Pediatrics , Massachusetts General Hospital , Boston , USA.,b Triangle Solutions , Dar es Salaam , Tanzania
| | - Megan E Kassick
- a Division of Global Health, Department of Pediatrics , Massachusetts General Hospital , Boston , USA
| | - Allan Kaijunga Kairuki
- a Division of Global Health, Department of Pediatrics , Massachusetts General Hospital , Boston , USA
| | - Robson Amunga Meda
- a Division of Global Health, Department of Pediatrics , Massachusetts General Hospital , Boston , USA
| | | | | | - Georgina Msemo
- d Ministry of Health and Social Welfare , Dar es Salaam , Tanzania
| | - Mary Azayo
- d Ministry of Health and Social Welfare , Dar es Salaam , Tanzania
| | - Brett D Nelson
- a Division of Global Health, Department of Pediatrics , Massachusetts General Hospital , Boston , USA.,e Harvard Medical School , Boston , USA
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5
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Arlington L, Kairuki AK, Isangula KG, Meda RA, Thomas E, Temu A, Mponzi V, Bishanga D, Msemo G, Azayo M, Nelson BD. Implementation of "Helping Babies Breathe": A 3-Year Experience in Tanzania. Pediatrics 2017; 139:peds.2016-2132. [PMID: 28557724 DOI: 10.1542/peds.2016-2132] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This first-ever country-level study assesses the implementation of the Helping Babies Breathe (HBB) program in 15 of Tanzania's mainland regions by measuring coverage, adoption and retention of provider skills, acceptability among providers, and barriers and challenges to at-scale implementation. METHODS Longitudinal facility-level follow-up visits assessed provider resuscitation knowledge and skills in using objective structured clinical examinations and readiness of facilities to resuscitate newborns, in terms of birth attendants trained and essential equipment available and functional. Focus group discussions were held with providers to determine the acceptability, challenges, and barriers to implementation of the HBB program. RESULTS Immediately after HBB training, 87.1% of providers passed the objective structured clinical examination. This number dropped to 79.4% at 4 to 6 weeks and 55.8% at 4 to 6 months (P < .001). Noting this fall-off in skills, the program implemented structured on-the-job training and supportive supervisory visits, which were associated with an improvement in skill retention. At long-term follow-up, >90% of facilities had bag-mask devices available to all beds in the labor and delivery ward, and 96% were functional. Overall, providers were highly satisfied with the HBB program but thought that the 1-day training used in Tanzania was too short, so they would welcome additional training and follow-up visits to reinforce skills. CONCLUSIONS The HBB program in Tanzania has gained acceptability and shown success in equipping providers with neonatal resuscitation knowledge, skills, and supplies. However, assessing the program's impact on neonatal mortality has proven challenging.
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Affiliation(s)
- Lauren Arlington
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Allan Kaijunga Kairuki
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kahabi G Isangula
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Robson A Meda
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Georgina Msemo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; and
| | - Mary Azayo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; and
| | - Brett D Nelson
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; .,Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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6
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Chaudhury S, Arlington L, Brenan S, Kairuki AK, Meda AR, Isangula KG, Mponzi V, Bishanga D, Thomas E, Msemo G, Azayo M, Molinier A, Nelson BD. Cost analysis of large-scale implementation of the 'Helping Babies Breathe' newborn resuscitation-training program in Tanzania. BMC Health Serv Res 2016; 16:681. [PMID: 27908286 PMCID: PMC5134300 DOI: 10.1186/s12913-016-1924-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. Methods We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Results Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. Conclusion HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention.
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Affiliation(s)
- Sumona Chaudhury
- Departments of Epidemiology and Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Lauren Arlington
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Shelby Brenan
- Departments of Epidemiology and Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Amunga Robson Meda
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Kahabi G Isangula
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | | | | | | | - Georgina Msemo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Alice Molinier
- Children's Investment Fund Foundation, London, W1S 2FT, UK
| | - Brett D Nelson
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA.,Departments of Pediatrics and Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 02115, USA
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7
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Reisman J, Martineau N, Kairuki A, Mponzi V, Meda AR, Isangula KG, Thomas E, Plotkin M, Chan GJ, Davids L, Msemo G, Azayo M, Nelson BD. Validation of a novel tool for assessing newborn resuscitation skills among birth attendants trained by the Helping Babies Breathe program. Int J Gynaecol Obstet 2015; 131:196-200. [PMID: 26283225 DOI: 10.1016/j.ijgo.2015.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/06/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To validate a simplified objective structured clinical examination (OSCE) tool for evaluating the competency of birth attendants in low-resource countries who have been trained in neonatal resuscitation by the Helping Babies Breathe (HBB) program. METHODS A prospective cross-sectional study of the OSCE tool was conducted among trained birth attendants working at dispensaries, health centers, or hospitals in five regions of Tanzania between October 1, 2013, and May 1, 2014. A 13-item checklist was used to assess clinical competency in a simulated newborn resuscitation scenario. The OSCE tool was simultaneously administered by HBB trainers and experienced external evaluators. Paired results were compared using the Cohen κ value to measure inter-rater reliability. Participant performance was rated by health cadre, region, and facility type. RESULTS Inter-rater reliability was moderate (κ = 0.41-0.60) or substantial (κ = 0.61-0.80) for eight of the OSCE items; agreement was fair (κ = 0.21-0.41) for the remaining five items. The best OSCE performances were recorded among nurses and providers from facilities with high annual birth volumes. CONCLUSION The simplified OSCE tool could facilitate efficient implementation of national-level HBB programs. Limitations in inter-rater reliability might be improved through additional training.
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Affiliation(s)
- Jonathan Reisman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Narra Martineau
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Allan Kairuki
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Amunga R Meda
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Kahabi G Isangula
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Triangle Solutions, Dar es Salaam, Tanzania
| | | | | | - Grace J Chan
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Leila Davids
- The Children's Investment Fund Foundation, London, UK
| | - Georgina Msemo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Brett D Nelson
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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