Assessing the capacity for newborn resuscitation and factors associated with providers' knowledge and skills: a cross-sectional study in Afghanistan
Assessing the capacity for newborn resuscitation and factors associated with providers' knowledge and skills: a cross-sectional study in Afghanistan
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DOI：
10.1186/1471-2431-13-140
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发表时间：
2013-09-10
期刊：
影响因子：
2.4
通讯作者：
Stekelenburg, Jelle
中科院分区：
文献类型：
--
作者：
Kim, Young Mi;Ansari, Nasratullah;Stekelenburg, Jelle
背景：使用袋子和面罩进行复苏是一种高影响力的干预措施，可以减少资源贫乏国家的新生儿死亡。这项研究评估了阿富汗提供全面产科和新生儿急救护理(EmONC)设施的新生儿复苏能力，以及与提供者的知识和临床技能相关的个人和设施特征。方法：评估者采访了78个设施的82名医生和142名助产士，了解他们对新生儿复苏的知识，并观察他们在解剖模型上执行程序。对每个设施的用品、设备和基础设施进行了评估。用STATA11.2和SAS 9.1.3软件进行描述性统计和单因素及多因素回归分析。结果：90%以上的新生儿复苏设施均配备了新生儿复苏所必需的设备，包括粘液抽取器、袋子和口罩。超过80%的提供者接受过新生儿复苏方面的培训，但助产士比医生更有可能接受这种培训作为职前教育的一部分(分别为59%和35%，p<；0.001)。医生和助产士在新生儿复苏方面的知识、临床技能或信心方面没有显著差异。医生和助产士在知识问题上的得分分别为71%和66%，在技能评估上的得分分别为66%和71%；75%的医生和83%的助产士对自己进行新生儿复苏的能力非常有信心。在多变量模型中，培训与更多的知识(P<；0.001)和临床技能(P<；0.05)相关，该模型根据设施类型、提供者类型和提供EmONC服务的多年经验进行了调整。结论：缺乏设备和培训不会构成阿富汗新生儿复苏的主要障碍，但提供者的知识和技能在某些领域需要加强。事实证明，助产士在进行新生儿复苏方面与医生一样有能力，这证明了在助产教育方面所作的重大投资是正确的。以能力为基础的职前和在职培训，辅之以支持性监督，是建设服务提供者实施新生儿复苏能力的有效途径。这种培训还可以帮助社区、私人诊所或初级保健机构的熟练助产士拯救新生儿的生命。
Background: Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in resource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering comprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility characteristics associated with providers' knowledge and clinical skills.Methods: Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn resuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and infrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses were performed using STATA 11.2 and SAS 9.1.3.Results: Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag, and mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely than doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No significant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in performing newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge questions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in their ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and clinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience offering EmONC services.Conclusions: Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan, but providers' knowledge and skills need strengthening in some areas. Midwives proved to be as capable as doctors of performing newborn resuscitation, which validates the major investment made in midwifery education. Competency-based pre-service and in-service training, complemented by supportive supervision, is an effective way to build providers' capacity to perform newborn resuscitation. This kind of training could also help skilled birth attendants based in the community, at private clinics, or at primary care facilities save the lives of newborns.