Abstract
Objectives
Newborn deaths comprise an alarming proportion of under-five mortality globally. In
this retrospective cohort study, we investigated the effectiveness of focused newborn
resuscitation training and delivery of a positive-pressure device in a rural midwife
population in a low-resource setting. The present research attempts to better understand
the extent to which knowledge and self-efficacy contribute to resuscitation attempts
by birth attendants in practice.
Methods
A one-year retrospective cohort analysis was undertaken in Aceh, Indonesia of two
groups of community-based midwives, one having received formal training and a positive-pressure
resuscitative device and the other receiving usual educational resources and management.
A path analysis was undertaken to evaluate relative determinants of actual resuscitation
attempts.
Results
348 community-based midwives participated in the evaluation and had attended 3116
births during the preceding year. Path analysis indicated that formal training in
resuscitation and delivery of a positive-pressure device were significantly related
to both increased knowledge (β = 0.55, p = 0.001) and increased self-efficacy (β = 0.52, p = 0.001) in performing neonatal resuscitations with a positive-pressure device. However,
training impacted actual resuscitation attempts only indirectly through a relationship
with self-efficacy and with knowledge. Combined across groups, self-efficacy was significantly
associated with positive pressure ventilation attempts (β = 0.26, p < 0.01) whereas knowledge was not (β = −0.05, p = 0.39).
Conclusion
Although, to date, evaluations of newborn resuscitation programs have primarily focused
on training and has reported process indicators, these results indicate that in order
to improve intrapartum-related hypoxic events (“birth asphyxia”), increased emphasis
should be placed on participant self-efficacy and mastery of newborn resuscitation.
Abbreviations:
AAP (American Academy of Pediatrics), HBB (Helping Babies Breathe), HIV (human immunodeficiency virus), IRB (Institutional Review Board), LMIC (low- and middle-income countries), MDG (Millennium Development Goals), NRP (newborn resuscitation program), SE (self-efficacy), TM (tube-and-mask positive-pressure device)Keywords
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Article info
Publication history
Published online: January 19, 2015
Accepted:
January 12,
2015
Received in revised form:
January 7,
2015
Received:
July 10,
2014
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
