## 4 Discussion
### Knowledge and Skills Assessment
(2018) suggested in their study that using several teaching methods and active lectures, such as practical demonstration workshops and assignments in reproductive and sexual health enhanced students' knowledge and confidence [41]. Other authors also indicated that a high level of knowledge retention can be achieved through the use of active learning methods and longitudinal reinforcement as a result of content integration across the four years of the study [16; 42]. Conversely, the reduction in knowledge retention in the 2019 post intervention assessment can be attributed to non-use or non-practice, which leads to long retention intervals. Historical data suggests that substantial knowledge decay is observed in general education knowledge with 70% retention after 1 year of nonuse; 40-50% after 2 years; 30% after 4 or more years [17]. However, the retention of basic science knowledge from medical school was found to be better depending on frequency of use or reinforcement. Despite the considerable knowledge increase observed in the 2017 post intervention assessment in the maternal and antenatal care component, which was correlated to the high number of female participants in the study, participants knowledge in the 2019 post intervention study dropped to the 2017 pre-intervention state indicating the high knowledge reduction that occurred in the two-year interval. One of the reasons that may be proffered for this observation may be explained from the result of the study carried out by [PERSON] et al. (2019) where they observed that the adequacy or appropriateness of teacher knowledge transfer significantly influences students' absorptive capacity and learning outcomes [43]. As such, lecture content and method of teaching must be pitched at a higher level compared to student's prior knowledge. In addition, participants learning outcomes may be compromised due to the knowledge of the current practice in South Africa where maternal and antenatal care services are provided by nurses at PHC facilities and in the rapidly expanding big chain community pharmacies [44]. This may have detracted from the experience leading undergraduate pharmacy students to believe that they do not have a role in MCH [3]. No baseline assessment was carried out for the infant growth assessment skills component due to timetable constraints (Figure 1). Although the 2017 post intervention assessment took place six months after the initial exposure, the participants recorded a mean score of 74.2%, which indicated adequate infant growth assessment skills and knowledge acquisition and retention. However, the mean score obtained in the 2019 post intervention assessment was significantly reduced to 55.1%. This may be attributed to non-use or insufficient practice of the acquired skills in the time period between the assessments although participants carried out an MCH component in a third-year externship. One of the reasons for the lack of practice would be the subtle elimination of pharmacists from MCH service delivery in pharmacies through the nurse-pharmacist alliances that exist especially in big chain retail pharmacies where most MCH services are provided by nurses [44]. Therefore, undergraduate pharmacy students who work either as post basic pharmacist's assistants from the second year of study or locum pharmacist's assistants from the fourth year of study in health facilities may have none or a few privileges of encountering MCH cases. A meta-analysis of the factors that influence skill loss and retention by [PERSON] et al. (1998) lends credence to the impact of non-use interval on skill retention [45]. He opined that there is a negative or inverse relationship between skills retention and the length of non-practice interval; as one increased, the other would decrease. He carried out a quantitative analysis of the relationship and showed that after more than one year of non-practice interval of a skill, performance reduces to less than 92% of the capability before the non-use interval.