P3.093: Implementing virtual simulations in neonatal care for health professionals in low- and middle-income countries

Background: One third of neonatal deaths occur on the infant’s first day of life, with 60% due to preventable causes. Most of these deaths occur in low- and middle-income countries. The Virtual Essential Newborn Care (vENC) simulations were developed to provide low-dose, high-frequency practice opportunities for newborn resuscitation and care, and to support ongoing practice and skills retention for health professionals recently trained in the World Health Organization’s Essential Newborn Care (ENC) course. Figure 1. Previous studies demonstrated that ENC plus vENC refreshers increased knowledge and skills in newborn resuscitation and neonatal care for nurses and midwives at all levels of facility practice and experience. However, little is known about the best practices for orienting health professionals practicing in LMICs to the use of virtual simulations.

Methods: We hypothesized that implementation approaches that incorporated a longer duration of in-class orientation would lead to greater utilization and performance on vENC scenarios in the first four weeks post-course. From Oct 2024-Mar 2025, vENC demonstrations were conducted as part of in-person ENC courses with health professionals (nurses, midwives and physicians) from primary, secondary and tertiary health facilities in Nigeria and Rwanda. The health professionals accessed the vENC course through an installed app on mobile devices. Site-specific approaches to implementation were identified through discussion with on-site facilitators. Data on frequency and duration of vENC use in the first 4 weeks after the course were analyzed by group to determine whether there were associations between implementation approach, level of practice, and uptake of vENC.

Results: Three groups of 57 participants were included in the analysis. All groups received in-person orientation using slides during the course, with access to remote tech support and automated reminders post-course. Group specific practices involved differences in the duration of time scheduled for practicing in class. Best practices were identified for access, instructions, and tips for success. The short orientation (SO) groups spent less than 30 min on in-class practice, while the long orientation (LO) groups spent 30-120 min. A total of 161 scenarios (75 SO, 86 LO, p=0.3) were completed in the 4 weeks post course. Participants in the LO group completed all 12 scenarios during the first 4 weeks post-course while those in the SO group completed 10 scenarios. The median number of scenarios completed was 3(IQR 3,4) SO vs. 4(IQR 2.5,7) LO. Median time spent 11.7(8.4,17.9)min SO vs. 13.4(10.1,17.2)min LO (p=0.15) and mean scores 82.0(12.4)% SO vs. 82.4(11.3)% LO (p=0.87) were similar. Figure 2.

Conclusion: Implementation practices for introducing virtual simulations on newborn care to health professionals in LMIC settings were explored and best practices defined. In the first month after introduction, there were no significant differences in frequency of use and performance between the short and long orientation approaches.