OLUWABIYI OO, DISU EA, MADISE-WOBO M, ANGA AL, IMAM Z, OLUTEKUNBI N.
Disclosure
This ENCC training was carried out with the support of
▪ Latter Day Saints Charities (LDS) and
▪ Abiye Maternal and Child Health International Foundation (AMCH) And the collaboration of ▪ Paediatric Association of Nigeria
▪ Federal Ministry of Health
▪ Lagos State Ministry of Health
Introduction/background
• Newborn deaths are a significant cause of under 5 mortality accounting for about 45% of child mortality globally
• It accounts for about 32% of child mortality in Nigeria and the three major causes are prematurity (31%), intrapartum complications (including birth asphyxia) (31%) and sepsis (22%).
•
• Lagos state of Nigeria has a very high neonatal mortality rate and Ikorodu LGA has one of the highest neonatal mortality rates in the state.
• The aim of this project was to increase neonatal survival by building capacity for neonatal care services at the secondary and primary health care levels in Ikorodu LGA.
Objectives
• To build the capacity of frontline health workers (birth attendants) on the revised ENCC (blended) by providing effective platform for updating knowledge of existing care providers in Ikorodu LGA in both theoretical and clinical aspects,
• To improve partnerships among neonatal healthcare providers.
• Measure the impact of training after a six-month post-training period on both perinatal asphyxia and neonatal mortality.
• Make recommendations to LSPHCB and LSMOH.
Methodology and Proceedings
• A pre training assessment of neonatal facilities in the LG was carried out
• Two five day residential “training of trainers” session was carried out to certify trainers (July 2016, March 2017)
•
• These went on to carry out 20 four-day step down trainings over an 18 month period (Aug 2016- Feb 2018)
• Participants were drawn from the 23 Public Primary Health Care facilities, 3 General Hospitals as well as 14 Private Hospitals in Ikorodu LGA
• A total of 831 participants were trained at an average of 42 per training.
• Trainings span 4 days.
• ENCC overview and the Newborn situation in Nigeria usually precedes each training.
• Module 1-4 (ENCC, HBB, ECEB and ECSB) was taught according to regulations. Each module was preceded by a pre-test and followed by a post-test.
• Lectures were delivered with the use of power points slides, flip charts by facilitators, role plays, facilitation simulations, facilitation practice, case scenarios and clinical practice sessions.
Results
ANALYSIS OF RETENTION OF KNOWLEDGE AND SKILL
ANY EFFECT ON NEWBORN CARE?
Gains
• Overall, there was significant knowledge and skill gain
• Knowledge retention loss was 20%
• There was no loss of retention for other essential newborn care skills. This could be attributed to the frequent use of these skills and practice on the job.
• Generally, the objective of the study was met as the overall neonatal mortality was significantly reduced at the two general hospitals evaluated viz Ikorodu GH and Ijede GH. This was in spite of a 6.5 fold and 4 fold increase in neonatal admissions respectively.
• Ijede General Hospital also upgraded their neonatal services so they were able to co-manage at the level of a General Hospital.
• More hospitals are now referring their babies in KMC position.
• Overall mortality has reduced as more babies are surviving and are being discharged.
• This training was well subscribed and linkages were established which encouraged and increased referrals to the General Hospitals.
Challenges
• No register to identify all health workers in the LG
• Hospital Management not always willing to release their staff for the four day training because of staff shortage.
• Community health workers yet to be trained. They are a major part of the primary health facilities
• There is no curriculum for the TBAs.
Way forward
• ENCC training should be mandatory for all medical staff involved in newborn care and skills should be upgraded at least once in two years (on going)
• Record keeping was very poor. A uniform template has been developed for data collection in all newborns delivered in all health institutions. (almost completed, awaiting Commissioner’s approval))
• All TBAs should be registered and their curriculum should be reviewed. The Modified ENCC training (meant for CHEWs) should be extended to TBAs and made available in vernacular for those with a language barrier.
• A continuous monitoring of TBA activities and on going interface between the Lagos State Government and the Traditional Medicine Board is recommended. Home deliveries by unregistered nurses should be forbidden and severely penalized. (already commenced)
• A skill station with a mannequin should be available on the ward for regular practice of acquired skills.
• Government needs to take ownership. Foreign sponsors may not always be available.
• Can step down trainings be done in two phases to accommodate private sector staff shortage concerns? (awaiting approval)
Facilitators
Facilitators and trainees at one of the trainings
On going training
Post training assessment
