Helping Babies Breathe in Nepal: Results of a Telephone Debriefing of Master Trainers - Abstract
Background: Millennium Development Goal 4 (MDG4) called for a two-thirds reduction in global child mortality from 1990 to 2015. Although the worldwide under-five (U5) mortality has decreased significantly, reductions in neonatal mortality have not been as dramatic. In Nepal, neonatal mortality has decreased slowly despite improvements in maternal and child health.Helping Babies Breathe® (HBB) training has been shown to decrease perinatal mortality. To assist with improving perinatal outcomes, the HBB program was initiated and disseminated in Nepal by Latter-day Saint Charities (LDSC).
Methods: From 2012 to 2015LDSC sponsored eight Helping Babies Breathe® (HBB) training of trainer (TOT) courses in Nepal to empower master trainers. LDSC implemented a relatively unsupervised, hospital-based, voluntary resuscitation training program, independent of government in-service training, in selected areas of Nepal. Atelephone debriefing system was established to maintain contact with master trainers on a monthly basis, for up to six months after the TOT, including (1) tracking the extent and the quality of the secondary training, and (2) encouraging and assisting master trainers in carrying out their training plan. The purpose of this study is to report the dissemination of training from this unique hospital-based program utilizing the findings from the telephone debriefing system.
Results: During the initial TOTs, 445 master trainers were trained. Of the 218 health care facilities represented at the TOTs, 216 (99.1%) participated in the telephone debriefing during at least one month (during the six-month follow-up period) following the TOT. Among participating facilities, 181 (84.2%) held an HBB training course during at least one follow-up month. A total of 124 (68.1%) facilities held only formal trainings, 44 (24.2%) held only informal trainings, and 14 (7.7%) held both formal and informal trainings. Master trainers reported training 4,464 providers, using HBB training methods, within six months of their respective TOT attendance. Factors found to be associated with number of providers formally trained included type of facility and training city.
Conclusion: The findings of this study suggest that the hospital-based, semi-autonomous implementation model resulted in significant secondary training of resuscitation techniques. Further, telephone debriefing systems can be feasibly used to track the scale-up of HBB training in Nepal. Finally, telephone contact can provide an opportunity for monitors to remind providers to hold trainings, offer needed advice and encouragement, and assess training successes and challenges.