Skills retention 3 months after neonatal resuscitation training in a cohort of healthcare workers in Sierra Leone

Sierra Leone has the highest neonatal mortality rate in the world, with one in 20 infants not surviving the neonatal period (Approx 50 deaths per 1000 live births) (1). Just over a third (35%) of these newborns die within 24 h of delivery (2). There is evidence that neonatal resuscitation programmes in low-resource settings may reduce neonatal mortality by up to 30% and reduce stillbirth rates (3). However, the ability to perform neonatal resuscitation in these settings is very limited (4). The dominant model of neonatal resuscitation training in Sierra Leone involves delivering one of several stand-alone training courses, with refresher training after 1 or 2 years, although some programmes offer ongoing mentorship after training. There is contrasting evidence on the effectiveness of this type of training, and the most effective mode of delivery, in resource-constrained settings (5). This study aimed to evaluate skills retention amongst healthcare workers 3 months after attending a 1-day Neonatal Basic Life Support (NBLS) course. The NBLS training course was developed locally, with input from local and overseas experts. It was delivered to healthcare workers from Bo Government Hospital and other local healthcare facilities in small groups over a period of 3 weeks in November 2013. The average instructor: student ratio was 1:8. The 1-day course covered neonatal resuscitation protocols based on guidelines published by the International Liaison Committee on Resuscitation (6) and the European Resuscitation Council (7) and adapted for use in the local setting. Resuscitation training involved immediate assessment of the newborn, meconium aspiration, initiation of resuscitation, drying technique, bag and mask ventilation, cardiopulmonary resuscitation, airway manoeuvres, appropriate use of oxygen when available and termination of resuscitation efforts. A clear protocol for immediate resuscitation was the central theme for the training programme. Advanced airway techniques were not covered, as there is no capacity in Bo district for neonatal ventilation. The use of medication during resuscitation was not taught, as they are not available locally and are not required in the majority of neonatal resuscitations. Guidance on how to recognise neonatal danger signs was also provided, as well as on general newborn care and the management of sepsis, hypoglycaemia and hypothermia. The course was similar in duration and content to others described previously in the literature (8–10). Training was delivered using a mixture of didactic teaching and practical, manikin-based training. There was a particular focus on practical resuscitation training scenarios. Students sat a practical exam immediately upon completion of the course – the primary skills test – where their practical skills were assessed in a simulated resuscitation scenario using a neonatal manikin. Each candidate was given a score out of 10, based on successfully completing a series of steps in the resuscitation process. Candidates were then invited back for a reassessment 12 weeks after completion of the course, for the purpose of internal quality control. During this assessment, they were given the same scenario that was assessed in the first exam and the same marking criteria were used. In both assessments, candidates were examined by one of two instructors, either an experienced physician or an experienced paediatric nurse with specific neonatal training. The Sierra Leone Research Ethics Committee advised that no formal ethics committee approval was required for this study as it was an internal quality assurance review. However, each participant, however, signed a consent form, agreeing that their results could be used in this study.