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Effectiveness of Helping Babies Breathe Training Among a Mixed Group of Healthcare Providers In Rwanda

Saturday, October 20, 2012: 9:28 AM
Room 346-347 (Morial Convention Center)
Danielle Yerdon Ehret, MD1, Cynthia F. Mann, MD1, Marietta Vazquez, MD1, Natalie McCall, MD, MPH2 and Linda D. Arnold, MD1, (1)Department of Pediatrics, Yale New Haven Hospital, New Haven, CT, (2)Department of Pediatrics, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda

Purpose

Helping Babies Breathe (HBB), a global educational program in neonatal resuscitation for birth attendants in resource-limited settings, has been shown to improve knowledge and skills in neonatal resuscitation.  HBB has been introduced in over 40 countries, where it has mostly targeted midwives, nurses and community healthcare workers.  We hypothesized that HBB training could also improve the knowledge and skills of medical students and physicians, who may be called to assist in newborn resuscitations, without having received sufficient training.

Methods

HBB training sessions were held at a university medical center and a community hospital in Kigali, Rwanda.  Sessions were led in English by a HBB master trainer (D.Y.E.).  Third and fourth-year medical students, pediatric residents, general practitioners, pediatric physicians, midwives and nurses participated in HBB training (N= 102).  Standardized HBB forms were used before and after training to assess bag and mask ventilation skills, via observation, and knowledge, through written multiple choice questions (MCQ).  Participants with limited proficiency in written English were allowed to complete the MCQ verbally; only complete written responses were included in the analysis.  Pre- and post-scores for knowledge and skill components were analyzed for the entire sample; comparisons of baseline and final scores were also made between medicine and nursing groups.

Results

102 participants completed HBB training (N= 40 medical students and physicians, N= 62 nurses and midwives).  Overall knowledge scores increased 8.3% (p<0.0001). There were no differences in pre- or post-knowledge scores between medicine and nursing groups.  Pre-training scores for bag and mask ventilation skills were significantly lower among medical students and physicians than for midwives and nurses (p= 0.03).  Following HBB training, skill scores for both groups were identical, having increased 19.9% among physicians and 11.7% among nurses.

Conclusion

Gains in knowledge and skills were attained by participants from varied backgrounds following HBB training in Rwanda. In settings like this, where physicians and medical trainees do not routinely attend deliveries, it is foreseeable that gaps in skills and knowledge may exist within this group. Our data support this concern, as scores for baseline skills were significantly lower in medical students and physicians, when compared with nurses and midwives, who were more likely to have received targeted training in newborn resuscitation.  This finding highlights the importance of including physicians, when appropriate, in global neonatal resuscitation training programs.  As resource-limited countries look to reduce neonatal morbidity and mortality through implementation of HBB, consideration should be given to including physicians and medical trainees, who may be called upon to resuscitate distressed newborns and should be armed with the necessary skills when problems arise.