Mobile Virtual Simulation Training in Essential Newborn Care for Healthcare Workers in Low and Middle Income Countries

项目摘要/摘要 2019年，有240万新生儿死亡，其中大部分是可以预防的。尼日利亚每1000名活产儿中有36人 是世界上新生儿死亡率最高的国家之一。新生儿死亡的前两位原因是 分娩时窒息或出生时呼吸困难或早产。新生儿复苏培训减少 与窒息相关的新生儿死亡率和发病率以及简单的干预措施，如温暖、温暖、手 洗澡，早期纯母乳喂养，脐带护理，眼睛护理，维生素K注射，以及 免疫接种可降低新生儿死亡率。然而，卫生保健工作者知识和技能的初步增长 迅速衰退，有时在训练后的几周内。面对面的进修培训和低剂量、高剂量 使用人体模型的频率(LDHF)练习是经过验证的教育方法，但需要设施空间， 设备和监督，这些在LMIC中往往由于缺乏基础设施、人员短缺和 员工流失率高。 另一方面，移动智能手机的高渗透率和LMIC中的蜂窝网络连接使 创新的移动虚拟仿真培训在LMICs是可行的。可以在学员的家中进行虚拟模拟 方便，在他们自己的智能手机上，具有基于游戏的自动反馈，是插曲学习的理想选择。 虚拟模拟进修培训提供了支持保留基本新生儿护理的机会 知识和技能随着时间的推移，并鼓励将这些技能移植到实际的临床实践中。我们建议 使用移动虚拟模拟提供可访问的、标准化的进修培训。 我们的假设是，虚拟模拟将提供可接受的、有效的进修培训；支持 在低收入家庭中心的医护人员中保留新生儿复苏和护理知识和技能；以及 降低新生儿死亡率。为了检验这些假设，我们将：1)开发和评估可用性、可行性、 虚拟新生儿基本护理(VENC)移动虚拟模拟的可接受性和教育效果 在社区和设施环境中护理新生儿的医护人员的基本新生儿护理； 2)进行阶梯式楔形整群随机对照试验，VINC用于复习训练与标准训练 练习一下。这将评估参与培训的venc复习培训对7天新生儿死亡率的影响。 医疗设施。我们还将衡量VINC培训对新生儿护理知识和技能的影响 在社区和设施环境中提供新生儿护理的医护人员。此外，我们还将致力于 与我们的合作伙伴微软合作，加强尼日利亚先进移动技术和研究的当地能力。 如果证明有效，venc移动模拟可以提供一种可用来降低新生儿死亡率的工具。 和发病率，并支持在低收入国家提供基本的新生儿护理。

PROJECT SUMMARY/ABSTRACT In 2019, there were 2.4 million newborn deaths, most of which are preventable. At 36 per 1000 live births, Nigeria has one of the highest neonatal mortality rates in the world. The top two causes of neonatal mortality are intrapartum asphyxia or failure to breathe at birth and prematurity. Neonatal resuscitation training reduces asphyxia-related newborn mortality and morbidity and simple interventions such as warmth, warmth, hand washing, early and exclusive breastfeeding, umbilical cord care, eye care, vitamin K administration, and immunization decrease neonatal mortality. However, initial gains in health care worker knowledge and skills rapidly decay, sometimes in a matter of weeks after training. In-person refresher training and low-dose, high frequency (LDHF) practice using manikins are proven educational approaches, but require facility space, equipment and supervision, that are often unavailable in LMICs due to lack of infrastructure, staff shortages and high rates of staff turnover. On the other hand, the high penetration of mobile smartphones and cellular network connectivity in LMICs make innovative mobile virtual simulation training feasible in LMICs. Virtual simulations can be engaged at the learner’s convenience, on their own smartphone, with game-based automated feedback that is ideal for episodic learning. Virtual simulation refresher training provides an opportunity to support the retention of essential newborn care knowledge and skills over time and to encourage migration of these skills into actual clinical practice. We propose to use mobile virtual simulations to provide accessible, standardized refresher training. Our hypotheses are that virtual simulations will provide acceptable, effective refresher training; support the retention of newborn resuscitation and care knowledge and skills among healthcare workers in LMICs; and reduce neonatal mortality. To test these hypotheses we will: 1) Develop and evaluate the usability, feasibility, acceptability and educational efficacy of Virtual Essential Newborn Care (vENC) mobile virtual simulations on essential newborn care in healthcare workers who care for newborns in community and facility-based settings; 2) Conduct a stepped wedge cluster randomized controlled trial of vENC for refresher training vs. standard practice. This will evaluate the impact of vENC refresher training on 7-day neonatal mortality rates at participating healthcare facilities. We will also measure the impact of vENC training on neonatal care knowledge and skills in healthcare workers who provide newborn care in community and facility-based settings. In addition, we will work with our partner, Microsoft to strengthen local capacity for advanced mobile technologies and research in Nigeria. If proven effective, the vENC mobile simulations could provide an accessible tool to reduce newborn mortality and morbidity and support the delivery of essential newborn care in LMICs.