P3.092: Implementing Essential Newborn Care and Quality Improvement Training- an ICATCH-supported project to train primary health workers in rural health centers in Enugu, Nigeria

Background: The neonatal mortality rate remains high in Nigeria, with the country having the fifth highest rate in the world. Many deaths are preventable with access to well-trained birth attendants and effective measures during childbirth. Enugu State has a neonatal mortality rate of 22 per 1000 live births. Perinatal asphyxia is a common cause of neonatal death in the community, and rural birth attendants have no access to ongoing training in newborn care. The project aimed to increase newborn care knowledge and resuscitation skills of rural health workers in Enugu, Nigeria by implementing Essential Newborn Care (ENC) and Quality Improvement (QI) training.

Methods: The project is funded by AAP’s ICATCH program. Participants were trained on ENC using the WHO ENC 1 modules. One full ENC training was conducted with refresher trainings every six months. Each healthy facility selected a QI champion lead QI work. QI workshops are held every 6 months – to fall in between ENC refresher trainings. The guide on Improving Quality of Basic Newborn Resuscitation in Low-resource Settings: A Framework for Managers and Skilled Birth Attendants, published by the USAID ASSIST Project, was used for the first QI workshop. Modifications are made to the refresher trainings based on the feedback and discussions from the QI workshop.

Results: Thirty primary health workers from 15 selected primary health centers in Enugu South local government area had ENC training. Fifteen QI champions participated in the QI workshop. Each of the selected health facilities was given a bag-and-mask device and ENC algorithm during the first ENC training. Following the first training, more participants (97%) passed the post-training knowledge check on the ENC 1 guide compared to 60% who passed the pre-training knowledge check (p-value < 0.0001). None of the participants passed the pre-training skill check. However, all the participants passed the post-training skill check (100%), (p-value < 0.0001). (Figure 1). Following the first QI training, some improvements were noted in the process indicators such as availability of bag-and-mask device during all deliveries and ENC algorithm in the delivery rooms. However, some facilities reported security challenges that led to no deliveries being carried out late in the evening and night period.

Conclusion: There was a significant increase in the knowledge and skills of ENC and newborn resuscitation of the health workers as a result of the trainings. This buttresses the need for continuous training on newborn resuscitation and ENC. The addition of QI workshops provided support in improving translation of ENC training to clinical practices. The QI workshops also provided a platform to better understand the lived experiences and challenges of the primary health workers with the goal over time to provide support in improving translation of ENC training to clinical practices.