Doctoral thesis
Background: Incompetence of nurses in the prevention and management of postpartum hemorrhage, eclampsia and neonatal resuscitation may lead to severe complications and deaths for both mothers and babies. Simulation-based training on obstetric and neonatal emergencies management has demonstrated promising results. However, its impact has not been well documented particularly in low and middle income countries.
Objective: The objective of this study was to determine the effectiveness of simulation based training on knowledge, skills, and attitude of nurses in managing maternal and newborn emergencies in primary health care settings in Dodoma region
Methods: A Quasi experimental study was conducted in 39 primary health centers covering all districts of the Dodoma region. A total of 176 nurses working in maternal and neonatal units were randomly selected to participate in the study. Knowledge on postpartum hemorrhage (PPH), eclampsia and Helping Babies Breathe (HBB) were assessed using validated tools. At baseline binary logistic regression analysis was used to dertemine independent predictors of knowledge, skills and attitude. The paired samples t test was run to determine mean difference before and after intervention. Multiple linear regression models were constructed to adjust for possible confounders of change in knowledge, skills and attitude at six months after intervention.
Results: At baseline mean (SD) knowledge scores for PPH, eclampsia and HBB was 10.041(± 2.161), 13.401(±2.658) and 12.954(±2.506) respectively. Changes in mean knowledge scores were observed; Immediately after the training; PPH
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(12.07±3.169), eclampsia (15.14 ±1.738) and HBB (14.70 ±1.738) respectively. Six months after the training; PPH (10.99 ±3.176), eclampsia (14.82±1.419) and HBB (14,13±1.174) respectively. All changes observed were statistically significant (P < 0.001).
At baseline mean skills scores for PPH, eclampsia and HBB were 13.349 (±8.376), 9.081(±5.311) and 8.552(±5.055) respectively. Changes in mean skills scores were observed; Immediately after training; PPH (23.895±9.793), eclampsia (14.797±6.256) and HBB (14.715±4.382) respectively. Six months PPH (15.529±5.939), eclampsia (10.826±4.394) and HBB (13.895±5.355) respectively. Significant changes in attitude were observed. All changes observed were statistically significant (P = 0.001).
Conclusions and recommendations.
Simulation-based training resulted on an improvement of knowledge, skills and attitude. Future research should focus on its impact on maternal and neonatal outcome.