Training Resources

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    Using a mobile nurse mentoring and training program to address a health workforce capacity crisis in Bihar, India: Impact on essential intrapartum and newborn care practices
    (Journal of Global Health, 2020-12-19) Creanga, Andreea A; Jiwani, Safia; Das, Aritra; Mahapatra, Tanmay; Sonthalia, Sunil; Gore, Aboli; Kaul, Sunil; Srikantiah, Sridhar; Galavotti, Christine; Shah, Hemant
    Background: To address a health workforce capacity crisis, in coordination with the Government of Bihar, CARE India implemented an on-the-job, on-site nurse mentoring and training intervention named – Apatkalin Matritva evam Navjat Tatparta (AMANAT, translated Emergency Maternal and Neonatal Care Preparedness) – in public facilities in Bihar. AMANAT was rolled-out in a phased manner to provide hands-on training and mentoring for nurses and doctors offering emergency obstetric and newborn care (EmONC) services. This study examines the impact of the AMANAT intervention on nurse-mentees’ competency to provide such services in Bihar, India during 2015-2017. Methods: We used data from three AMANAT implementation phases, each covering 80 public facilities offering basic EmONC services. Before and after the intervention, CARE India administered knowledge assessments to nurse-mentees; ascertained infection control practices at the facility level; and used direct observation of deliveries to assess nurse-mentees’ practices. We examined changes in nurse-mentees’ knowledge scores using χ2 tests for proportions and t tests for means; and estimated proportions and corresponding 95% confidence intervals for routine performance of infection control measures, essential intrapartum and newborn services. We fitted linear regression models to explore the impact of the intervention on nurse-mentees’ knowledge and practices after adjusting for potential confounders. Results: On average, nurse-mentees answered correctly 38% of questions at baseline and 68% of questions at endline (P < 0.001). All nine infection control measures assessed were significantly more prevalent at endline (range 28.8%-86.8%) than baseline. We documented statistically significant improvements in 18 of 22 intrapartum and 9 of 13 newborn care practices (P < 0.05). After controlling for potential confounders, we found that the AMANAT intervention led to significant improvements in nurse-mentees’ knowledge (30.1%), facility-level infection control (30.8%), intrapartum (29.4%) and newborn management (24.2%) practices (all P < 0.05). Endline scores ranged between 56.8% and 72.8% of maximum scores for all outcomes. Conclusion: The AMANAT intervention had significant results in a health workforce capacity crisis situation, when a large number of auxiliary nurse-midwives were expected to provide services for which they lacked the necessary skills. Gaps in intrapartum and newborn care knowledge and practice still exist in Bihar and should be addressed through future mentoring and training interventions.
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    The thistle study: a stepped-wedge clustered trial of an intrapartum emergencies training package in Scottish maternity units
    (Trails, 2013-11-29) Lenguerrand, Erik; MacLennan, Graeme; Siassakos, Dimitrios; Draycott, Timothy; Bhattacharya, Siladitya; Norrie, John
    Background: The Stepped-Wedge clustered RCT(SW-cRCT) design is often proposed, but less often executed. It appears to offer significant advantages for intervention where on balance the outcome is likely to be beneficial. It pragmatically implements the intervention for all sites, reduces the logistical/financial challenges of implementation at scale, whilst providing a robust framework for the study of effect trends. This presentation describes the protocol of the Thistle study, a SW-cRCT evaluating the effectiveness of a training aiming to improve perinatal care and outcomes in term babies across Scotland. Study: This study will be conducted between September 2013 and February 2016 for 12 maternity units, and will have five steps, each step lasting six months. Four units per step will be randomized to the intervention at one of the three possible randomisation steps. Each unit will be followed for a minimum of 12 months to investigate effect trends (between 2 to 4 follow-up steps). Intervention: PROMPT, a multiprofessional team training for maternity staff (http://www.promptmaternity.org). Data: Routinely collected information from the Scottish Morbidity Record(SMR02) submitted by maternity hospitals will be interrogated. Statistical analysis: The prevalence of babies born with a low Apgar score will be modelled using generalized linear mixed models to investigate the intervention effect, taking appropriate account of the clustering (babies within maternity units). Secondary analyses will adjust for time intervals (steps modelled as fixed effects) and potential interactions between time and treatment effects. Conclusion: This presentation aims to provide a methodological insight of a SW-cRCT to share experience about a type of trial design under-used and under-documented.