Rwanda is among the developing countries in the world. In 2015, 39% of its population was living under poverty line (National Institute of Statistics of Rwanda, 2014). It is a landlocked country with an area of 26,338 square kilometers located in East Africa. In spite of Rwanda achieving Millennium Development Goals (MDGs) related to reducing child mortality, neonatal mortality remains high, at 29 deaths per 1,000 births (National Institute of Statistics of Rwanda, 2014) and birth asphyxia is one of the leading causes of death.
In Rwanda, birth asphyxia accounts for 33% of all neonatal deaths (Rwanda Ministry of Health, 2013). Birth asphyxia is the failure to establish breathing at birth and it is recognized as one of the leading cause of newborn deaths (Aslam et al. 2014). Globally, 2.9 million neonates die annually, and 900,000 deaths are attributed to neonatal birth asphyxia (Enweronu-Laryea & Robertson, 2017). In 2016, the World Health Organization (WHO, 2017) report shows that newborns accounted for 46% of all deaths among children under five. Although, the same report acknowledges a decline of deaths among the children under five years, the proportion of newborn deaths increased from 41% to 46%.
Similarly, several reports show neonates deaths as a global challenge (Enweronu-Laryea & Robertson, 2017), particularly in countries where birth attendants have lower education, less resuscitation skills and limited resources. A study conducted in one Ethiopian hospital from July 2014 to June 30, 2017, reveals that of 9,738 babies who were born during the study period, 302 (3.1%) had birth asphyxia (Ibrahim, Muhye, & Abdulie, 2017). In addition, a study conducted in Kenya by Murila, Obimbo, and Musoke (2012) shows that only 30% of neonatal frontline providers passed a neonatal resuscitation assessment test. The same study reports that 70% of neonatal care providers identified the lack of refresher training in neonatal resuscitation as a key factor leading to low confidence in skills of resuscitation. Thus, one can attribute some of the asphyxia related death to lack of skills in neonatal resuscitation.
As a part of addressing the challenge, simple steps for neonatal resuscitation referred to as helping babies breathe (HBB), were developed by American Academy of Pediatrics (AAP) in 2010 (AAP, 2016). Studies reveal the correlation of HBB based intervention and the decrease of neonatal deaths (Aslam et al., 2014; Eblovi et al., 2017). Similarly, a qualitative study that was conducted by Kasine (2017) in Rwanda, reveals the possibility of improving neonatal resuscitation skills among health care providers.
It is in this regard that the Training Support and Access Model (TSAM) is conducting mentorship on Maternal, Neonatal and Child Health (MNCH) of which neonatal resuscitation or HBB is a component of the mentorship package to maternity nurses and midwives. TSAM is a Canadian government-sponsored project assisting Rwanda in the area of MNCH services.
Purpose:
The purpose of this study is to assess the impact of a mentorship program on nurses and midwives’ knowledge and self-efficacy related to resuscitation skills in the first minute of life i.e. HBB.
Methods:
TSAM is using its team of nursing and midwife experts in MNCH to conduct mentorship sessions at all health centers of Gicumbi, Gakenke and Rulindo districts. The researchers for the current study were not involved directly with developing or delivering the mentorship intervention, rather they were assessing and comparing pre-and-post mentorship knowledge and self-efficacy of 141 nurses and midwives who are participating in the mentorship. The mentorship program involves a series of monthly visits from TSAM mentors over a six-month period (from September 2018 – March 2019). This study used instruments of two types: the HBB self-efficacy scale adapted from Bandura (2006), and the HBB knowledge questionnaire adapted from AAP (2016). The variables of self-efficacy were measured using Bandura (1977) Self-Efficacy Scale (SES) after adapting it to the local context and content of neonatal resuscitation in Rwanda. The SES is a 24-item scale that measures a nurse’s confidence to perform neonatal resuscitation interventions. All self-efficacy items are rated on a 10-point Likert scale ranging from 0 (not confident at all) to 10 (very confident) and a final score is calculated by averaging all 24 items. In addition, the HBB knowledge scale that was developed by American Academy for Pediatrics (AAP) is being used for pre-and-post HBB mentorship intervention in assessing the knowledge. It is a multiple choice-based tool with 18 questions about resuscitation knowledge during the golden minute (the first minute of life). The tool is evaluated on a scale of 18 where 0/18 reveals no knowledge of HBB at all, while 18/18 is the maximum HBB knowledge score. The knowledge scores were converted to percentage for easier understanding.
Results:
Preliminary results from pre-mentorship assessment show that 69.5% (n=98) of participants were females, 30.5% (n=43) have only secondary education while 64.5% (n=91) have advanced education. 67.4% (n=95) of participants have never had any training or information on helping a baby breathe in the first minute of life. The participants’ mean knowledge score for neonatal resuscitation was 78.5% (SD=12.08). Participants’ score for neonatal resuscitation self-efficacy mean is 7.19 (SD=1.91). Pre-mentorship knowledge and self-efficacy show a moderate correlation (r=.18, p=.014). In addition, for those report having previous neonatal resuscitation training, the knowledge mean was higher than for those who claim to have never had it (81.58 vs 77.01 p = .035). Similarly, for those reporting to have had previous training about neonatal resuscitation, the self-efficacy mean was higher than for those without the training (7.7 vs 6.9, p= .01). While this previous training was not part of the TSAM mentorship intervention, the results do suggest the potential impact of specific HBB training. Data from the post-mentorship survey will not be available until April 2019 thus comparison of pre and post data will be presented where possible.
Conclusion:
The preliminary results suggest that providing information related to helping babies breathe could improve knowledge and self-efficacy. The study will continue to assess the potential impact of the mentorship program on helping babies breathe to determine if it will enhance knowledge and self-efficacy pertaining for neonatal resuscitation for nurses and midwives in Rwandan health centres. It is possible that the findings from HBB mentorship intervention will not only equip these nurses and midwives with extra knowledge, skills, self-efficacy for newborn resuscitation but also that it will ultimately be adopted by the national health care administration in Rwanda to help reduce neonatal mortality and increase the self-efficacy for newborn resuscitation in Rwandan health care providers.