# Neonatal resuscitation skills retention among healthcare providers one year after implementation of in situ low-dose high-frequency simulations using innovative tools across two regions in Tanzania

## TL;DR

Healthcare providers in Tanzania retained most neonatal resuscitation skills a year after training with innovative simulation tools, though male providers showed more skill decline.

## Contribution

Demonstrates the effectiveness of in situ low-dose high-frequency simulations using innovative tools for long-term skill retention in neonatal resuscitation in resource-limited settings.

## Key findings

- 174 out of 226 healthcare providers retained resuscitation skills one year after training.
- Male healthcare providers were less likely to retain skills compared to females.
- A mean skills score drop of 10.2% was observed from baseline to one year post-training.

## Abstract

The Safer Births Bundle of Care (SBBC) was introduced in five regions in Tanzania to improve the quality of care around birth. Among the interventions was an initiative to train healthcare providers on neonatal resuscitation following the Helping Babies Breathe curriculum, using innovative simulation tools.

This study aimed to assess simulated neonatal resuscitation skills retention and associated factors one year after implementation.

A longitudinal study among healthcare providers working in the labour wards of 12 facilities in two regions undergoing SBBC implementation. Healthcare providers were trained and evaluated at baseline and one year after implementation of in situ self-regulated individual skill training. A paired t-test was used to compare the mean difference in skills scores, while factors associated with skills retention were assessed using a modified Poisson regression analysis.

Among 226 participants, 174 (77%) retained skills one year after the implementation. The mean skills score at baseline was 92.5% compared to 82.3% after one year, with a mean difference of 10.2 (95% CI: 8.7–11.7); p < 0.001. Sex was independently associated with skills retention; males were less likely to retain skills than females, with an adjusted prevalence ratio (APR) = 0.90 (95%CI: 0.86–0.97); p = 0.02.

The majority of healthcare providers retained simulated neonatal resuscitation skills. There was an overall mean skills drop compared to baseline, highlighting the need to strengthen the approaches supporting long-term skills retention. Barriers to and facilitators of sustained effects and scalability should be explored.

Main findings: The majority of healthcare providers retained newborn resuscitation skills one year after implementation of frequent in-facility self-regulated simulation training using innovative tools. Male sex was significantly associated with skills decay.Added knowledge: This study highlights the effect of frequent in situ self-regulated simulations using innovative tools to retain neonatal resuscitation skills among healthcare providers in resource-limited settings. This has the potential to improve the quality of care and improved survival of newborns.Global health impact for policy and action: Incorporation of frequent in situ simulations using innovative training tools as part of continuous quality improvement efforts is important to ensure sustained skills among healthcare providers, with the potential to improve the quality of newborn care.

Main findings: The majority of healthcare providers retained newborn resuscitation skills one year after implementation of frequent in-facility self-regulated simulation training using innovative tools. Male sex was significantly associated with skills decay.

Added knowledge: This study highlights the effect of frequent in situ self-regulated simulations using innovative tools to retain neonatal resuscitation skills among healthcare providers in resource-limited settings. This has the potential to improve the quality of care and improved survival of newborns.

Global health impact for policy and action: Incorporation of frequent in situ simulations using innovative training tools as part of continuous quality improvement efforts is important to ensure sustained skills among healthcare providers, with the potential to improve the quality of newborn care.