Accelerating Newborn Survival in Ghana Through a Low-dose, High-frequency Health Worker Training Approach

Study Overview
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Brief Summary
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This study assesses the effect of a low-dose, high-frequency training approach on long-term evidence-based skill retention among skilled birth attendants and impact on adverse birth outcomes at hospitals in Ghana.

Detailed Description
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In-service training for skilled birth attendants (SBAs) is one of the most common interventions to address lack of knowledge and skills. However, these training interventions are seldom evaluated for effectiveness in improving learning or performance. This study study is a cluster-randomized waitlist trial implemented in 40 public and mission hospitals in Ghana. It assesses the effect of a low-dose, high-frequency (LDHF) training approach to update hospital-based SBAs in key evidence-based intrapartum and immediate newborn care practices, using current global guidelines.The LDHF approach includes two 4-day onsite sessions (low dose) with weekly practice sessions, SMS quizzes and reminders, and mentoring via mobile phone and onsite visits between trainings (high frequency). The low-dose sessions include competency acquisition through simulation, case-based learning, and small content packages spread over short time intervals. Eligible hospitals will be stratified by geographic region and caseload, and then randomly assigned to one of four implementation waves. The pipeline randomization allows for rigorous evaluation while the program is rolled out to all facilities.

Official Title
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Accelerating Newborn Survival in Ghana Through a Low-dose, High-frequency Health Worker Training Approach

Conditions
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Stillbirth, Neonatal Death

Intervention / Treatment
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* Behavioral: Low dose high frequency health worker training approach
* Behavioral: Active Comparison


Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA - FACILITIES: Public or faith based hospital At least three skilled birth attendants on staff At least 30 births per month EXCLUSION CRITERIA - FACILITIES: Private hospital Public or faith based hospital with less than three skilled birth attendants on staff Public or faith based hospital with less than 30 births per month INCLUSION CRITERIA - SERVICE PROVIDERS: * Health providers who attend births in participating health facilities and consent to be assessed at the time of enrollment and at several points in time over the study period EXCLUSION CRITERIA - SERVICE PROVIDERS: * Health providers who decline to participate
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Low-dose high-frequency health worker training approach to update skilled birth attendants in key evidence-based intrapartum and immediate newborn care practices | Behavioral: Low dose high frequency health worker training approach<br>* Two 4-day training sessions for skilled birth attendants 1-day peer practice coordinator training after first training session Weekly, peer-led practice sessions using MamaNatalie® and NeoNatalie™ anatomic models SMS reminder messages and quizzes Routine telephone calls between master mentors and peer practice coordinators, and between project staff and master mentors Health information officer training Data collection and use training Supply of simulators, newborn resuscitation equipment, and delivery sets<br>|
| Active Comparator: Comparison<br>Training on data collection and reporting | Behavioral: Active Comparison<br>* Training on data collection and reporting<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| institutional twenty-four hour newborn mortality rate | death within 24 hours, or before discharge, of a newborn who breathed at birth | 1 day | 
| institutional intrapartum stillbirth rate | proportion of all facility births that resulted in intrapartum stillbirth | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| skilled birth attendant knowledge and skills | score on written and practical examinations on routine and emergency obstetric and newborn care | Pre-test (before training) - post-test (immediately after training) - endline (12 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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institutional delivery