4 Domain Attitude Example: “How comfortable are you with neonatal resuscitation?” Likert scale, 1–4, Not at all to very comfortable, scored on quartiles: 1 = 25%, 2 = 50%, 3 = 75%, 4 = 100% Knowledge Example: “Restoration of adequate ventilation usually will result in a (rapid) (gradual) (slow) improvement in heart rate.” Dichotomous correct or incorrect answer scored. Skills Example: “Please demonstrate the proper method of positive-pressure ventilation.” Dichotomous correct or incorrect answer scored. 1 Combined Students’ paired t-Test with two-tailed distribution, (P = .02). 45 30 58 Table 2: Changes in trainees’ attitude, knowledge, and skills in neonatal resuscitation. International Journal of Pediatrics Mean preintervention score (percent correct) Mean postintervention score1 (percent correct) Table 3: Birth outcomes at St. Gabriel’s Hospital before and after LPCH neonatal resuscitation training. Total deliveries Total neonatal deaths Total maternal deaths Neonatal mortality Maternal mortality 5-minute Apgar score less than 5 Preintervention 3449 72 14 20.876 per 1000 4.059 per 1000 131 Fisher’s exact test indicates that the diﬀerence between pre- and postintervention percent neonatal mortality is not statistically signiﬁcant, (P = 0.86). The diﬀerence between pre- and postintervention percent maternal mortality is not statistically signiﬁcant, (P = 0.24). Human Research Protection Program’s deﬁnitions of human subject research because we did not obtain or receive private, individually identiﬁable information. 3. Results Fourteen of 26 birth attendants at St. Gabriel’s received training at St. Gabriel’s Hospital in September 2008. The trainees consisted of two physicians, eight clinical oﬃcers, and four midwives. No trainees had previous neonatal resuscitation training and all trainees worked in the labor ward, antenatal unit, and female ward from October 2008 to December 2009. One trainee was further trained as an instructor. The pre-/posttest comparison evaluating all aspects of the module found that training scores improved from an average of 38.6% to 64.4%: attitude scores improved from 45% to 76.3%, knowledge scores improved from 30.4% to 58.7%, and skills scores improved from 57.5% to 75.5%, (P = .02) (Table 2). A total of 6 694 neonates born at St. Gabriel’s Hospital were studied. There were 3 449 births preintervention and 3 515 births postintervention (Table 3, see the appendix). The neonatal mortality rate across the study’s ﬁrst 15 months (before intervention) was 20.9 neonatal deaths per 1000 live births compared to 21.9 neonatal deaths per 1000 live births in the 15 months after intervention, a 0.10% diﬀerence, (P 0.86) (Table 3). The ﬁve-minute Apgar score less = than 5 fell from 131 preintervention to 66 postintervention (Table 3). Complete data on neonatal deaths (to 28 days) was not available; only in-hospital deaths are recorded. Maternal mortality was 4.1 maternal deaths per 1000 live births preintervention compared to 2.0 maternal deaths per 1000 live births postintervention, (P = 0.24) (Table 3). 4. Discussion The results of our study reject the hypothesis that neonatal mortality rates are lower at St. Gabriel’s Hospital following the LPCH neonatal resuscitation curriculum intervention, despite the positive results of the pre-/postintervention evaluation. This highlights the necessity for evaluating interventions at the level of the primary outcome—in this case, neonatal mortality—and not relying on intermediary results like trainee attitude, knowledge, and skills. While the neonatal mortality rates before the LPCH neonatal resuscitation curriculum (20.9 neonatal deaths per 1000 live births) and after the intervention (21.9 per 1000) were not statistically diﬀerent, it is interesting to note that the neonatal complication of a ﬁve-minute Apgar score less than 5 was decreased postintervention. It is possible that the LPCH neonatal resuscitation training had a positive impact for a small group of health providers reﬂected by the reduction of the ﬁve-minute Apgar score less than 5 from 131 preintervention to 66 postintervention. However, it appears 76 59 76 Postintervention 3515 77 7 21.906 per 1000 1.991 per 1000 66