Accelerating Newborn Survival in Ghana Through a Low-dose, High-frequency Health Worker Training Approach

This study assesses the effect of a low-dose, high-frequency training approach on long-term evidence-based skill retention among skilled birth attendants and impact on adverse birth outcomes at hospitals in Ghana.

Study Overview

• Status: Completed
• Conditions: Stillbirth; Neonatal Death
• Intervention / Treatment: Behavioral: Low dose high frequency health worker training approach; Behavioral: Active Comparison

Detailed Description

In-service training for skilled birth attendants (SBAs) is one of the most common interventions to address lack of knowledge and skills. However, these training interventions are seldom evaluated for effectiveness in improving learning or performance.

This study study is a cluster-randomized waitlist trial implemented in 40 public and mission hospitals in Ghana. It assesses the effect of a low-dose, high-frequency (LDHF) training approach to update hospital-based SBAs in key evidence-based intrapartum and immediate newborn care practices, using current global guidelines.The LDHF approach includes two 4-day onsite sessions (low dose) with weekly practice sessions, SMS quizzes and reminders, and mentoring via mobile phone and onsite visits between trainings (high frequency). The low-dose sessions include competency acquisition through simulation, case-based learning, and small content packages spread over short time intervals.

Eligible hospitals will be stratified by geographic region and caseload, and then randomly assigned to one of four implementation waves. The pipeline randomization allows for rigorous evaluation while the program is rolled out to all facilities.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

INCLUSION CRITERIA - FACILITIES:

• Public or faith based hospital
• At least three skilled birth attendants on staff
• At least 30 births per month

EXCLUSION CRITERIA - FACILITIES:

• Private hospital
• Public or faith based hospital with less than three skilled birth attendants on staff
• Public or faith based hospital with less than 30 births per month

INCLUSION CRITERIA - SERVICE PROVIDERS:

* Health providers who attend births in participating health facilities and consent to be assessed at the time of enrollment and at several points in time over the study period

EXCLUSION CRITERIA - SERVICE PROVIDERS:

* Health providers who decline to participate

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Low-dose high-frequency health worker training approach to update skilled birth attendants in key evidence-based intrapartum and immediate newborn care practices	Behavioral: Low dose high frequency health worker training approach; Two 4-day training sessions for skilled birth attendants; 1-day peer practice coordinator training after first training session; Weekly, peer-led practice sessions using MamaNatalie® and NeoNatalie™ anatomic models; SMS reminder messages and quizzes; Routine telephone calls between master mentors and peer practice coordinators, and between project staff and master mentors; Health information officer training; Data collection and use training; Supply of simulators, newborn resuscitation equipment, and delivery sets
Active Comparator: Comparison; Training on data collection and reporting	Behavioral: Active Comparison; Training on data collection and reporting

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
institutional twenty-four hour newborn mortality rate	death within 24 hours, or before discharge, of a newborn who breathed at birth	1 day
institutional intrapartum stillbirth rate	proportion of all facility births that resulted in intrapartum stillbirth	1 day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
skilled birth attendant knowledge and skills	score on written and practical examinations on routine and emergency obstetric and newborn care	Pre-test (before training) - post-test (immediately after training) - endline (12 months)

Collaborators and Investigators

• Sponsor: Jhpiego
• Collaborators: Bill and Melinda Gates Foundation
• Investigators: Principal Investigator: Patricia Gomez, Senior Technical Advisor

Publications and helpful links

General Publications

• Gomez PP, Nelson AR, Asiedu A, Addo E, Agbodza D, Allen C, Appiagyei M, Bannerman C, Darko P, Duodu J, Effah F, Tappis H. Accelerating newborn survival in Ghana through a low-dose, high-frequency health worker training approach: a cluster randomized trial. BMC Pregnancy Childbirth. 2018 Mar 22;18(1):72. doi: 10.1186/s12884-018-1705-5.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2014
• Primary Completion (Actual): February 28, 2017
• Study Completion (Actual): February 28, 2017

Study Registration Dates

• First Submitted: September 19, 2017
• First Submitted That Met QC Criteria: September 19, 2017
• First Posted (Actual): September 25, 2017

Study Record Updates

• Last Update Posted (Actual): September 25, 2017
• Last Update Submitted That Met QC Criteria: September 21, 2017
• Last Verified: September 1, 2017

More Information

Terms related to this study

• Keywords: institutional delivery
• Additional Relevant MeSH Terms: Pathologic Processes; Pregnancy Complications; Death; Fetal Death; Perinatal Death; Stillbirth
• Other Study ID Numbers: OPP1087303

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No