Impact of New Tools of Simulation-enhanced Peer Learning on Neonatal and Maternal Mortality

Study Overview
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Brief Summary
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In the vast majority of developing nations, frontline birth attendants are often the only care providers responsible for newborn care including newborn resuscitation, thermal care, feeding and administration of medications. These midwives need knowledge and skills to provide all these newborn clinical care needs. However, frontline birth attendants in these circumstances are seldom exposed to the training and decision support tools that would empower them to holistically assess, decide and manage newborn babies in their care. Current training opportunities are fragmented and need to be administered as a comprehensive package. A combination approach to training, skills retention, and the use of decision support tools such as Protecting Infants Remotely by SMS (PRISMS) and Augmented Infant Resuscitator (AIR) may provide a comprehensive package for the acquisition and retention of knowledge and skills on newborn care and empower birth attendants to provide effective, timely interventions.

Detailed Description
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The investigators will implement the Sim for Life Impart, Retain, Empower and Monitor (IREM) module at the University of Jos teaching Hospital and 4 high volume health facilities in Tanzania in addition to the Uganda sites. We propose to implement the program with all its components for each of the partner institutions. The Sim for Life IREM module combines four strategies: Impart skills using Helping Babies Survive (HBS)/Helping Mothers Survive (HMS) courses, Retain skills (Simulation), Empower birth attendants (PRISMS and AIR) and Monitor progress objectively. The simulation sessions for health facilities will be conducted using the peer to peer learning methodology which equips participants with the skills to facilitate simulation scenarios in their health facilities. The scenarios will be provided by the Sim for life team. The topics for the scenarios will be based on common maternal and newborn illnesses like post-partum hemorrhage, pre-eclampsia, birth asphyxia, neonatal sepsis and prematurity. All health facilities in this study will require smart phones for the PRISMS application, resuscitation practice tables, source of electricity to charge a phone, practice manikins / associated practice supplies and peer learning cards.

Official Title
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Impact of Simulation-enhanced Peer Learning With Novel Tools on Maternal and Newborn Mortality Plus Knowledge, Skills Retention and Decision Making by Front-line Health Workers in Southwestern Uganda

Conditions
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Neonatal Mortality, Maternal Mortality

Intervention / Treatment
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* Other: Active peer learning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Newborns babies Mothers delivering at participating health facilities Health workers providing maternal and newborn care services at participating health facilities Exclusion Criteria: Health care workers not providing maternal and newborn care services Male patients Non pregnant female patients seeking care at participating health facilities

Ages Eligible for Study
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Minimum Age: 0 Days

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
Interventional Model Description: Randomized cluster trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>HMS, HBS and peer learning in combination with AIR and PRISMS | Other: Active peer learning<br>* HMS, HBS and peer learning in combination with AIR and PRISMS<br>* Other names: Enhanced HMS and HBS with PRISMS and AIR;|
| Active Comparator: Comparison arm<br>HMS, HBS and peer learning in combination with PRISMS but no AIR | Other: Active peer learning<br>* HMS, HBS and peer learning in combination with AIR and PRISMS<br>* Other names: Enhanced HMS and HBS with PRISMS and AIR;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neonatal mortality | Neonatal mortality | Neonatal mortality at 6 months | 
| Neonatal mortality | Neonatal mortality | Neonatal mortality at 18 months | 
| Maternal mortality | Maternal mortality | Maternal mortality at 6 months | 
| Maternal mortality | Maternal mortality | Maternal mortality at 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of stay in hospital | Number of days as length of stay | 18 months | 
| Completeness of newborn assessment | Completeness of newborn assessment checklist | At admission |