P3.081: Customized remote essential newborn care training and mentorship in Tanzania improves knowledge and skills

Background: Worldwide, 2.3 million newborns die annually, and Sub-Saharan Africa has the highest global neonatal mortality rate. As skilled care at birth can reduce these numbers, the World Health Organization (WHO) recommends Essential Newborn Care 1 (ENC1) training to provide necessary knowledge and skills for newborn healthcare workers. In conjunction with ENC, the American Academy of Pediatrics (AAP) developed a Customized mentoRship and Implementation Support Package (CRISP). CRISP uses training, mentorship, and tools to improve healthcare systems and allow education to impact clinical care. This study aimed to evaluate a remote CRISP training for ENC1 at six regional hospitals in Tanzania between 2023 and 2024.

Methods: AAP technical advisors trained in-country Tanzanian facilitators in ENC1 via four remote sessions for a total of 12 hours. In-country facilitators cascaded the training in their respective regional hospitals including Mtwara, Morogoro, Mbeya, Lindi, Pwani, and Katavi. Participants were evaluated at baseline, post-training, and after CRISP sessions with the standardized ENC1 Knowledge Check, bag and mask ventilation (BMV) checklist and two objective structured clinical evaluations (OSCE A & B). After training and evaluation, participants met remotely every 2-4 weeks for eight CRISP mentorship sessions via an ECHO (Extension for Community Healthcare Outcomes) platform (Figure 1). Session topics were informed by a needs survey from participants and included challenges with training, sustaining training, and quality improvement. Qualitative interviews and focus group discussions are planned in 2025 for project coordinators, in-country facilitators, and healthcare workers.

Results: Three technical advisors (from Canada, United States, and South Africa), 44 Tanzanian in-country facilitators, and 92 Tanzanian newborn healthcare workers participated. In-country facilitators had a baseline pass rate of 86.1% on the knowledge check, which improved to 100% post-training and remained at 100% after CRISP sessions. Healthcare workers had a baseline pass rate of 69.6% on the knowledge check, improving to 87.5% after training and 95.7% after CRISP sessions. For the BMV checklist, in-country facilitators had a baseline pass rate of 60.0%, which improved to 88.9% post-training and 100% after CRISP sessions. Healthcare workers had an initial BMV checklist pass rate of 48.1%, improving to 94.9% after training and 100% after CRISP sessions. For OSCE A and B, there were increases in pass rates from the end of training to the end of CRISP sessions in both groups (Figure 2).

Conclusion: In this group of in-country facilitators and healthcare workers in Tanzania, remote ENC1 training and mentorship effectively maintained knowledge and skills for six to twelve months after initial training. This is important as resuscitation knowledge and skills generally demonstrate a linear decline over time without additional practice. Additional interviews and focus group discussions may provide information on remote mentorship feasibility to further improve the CRISP model.