abstract: 'Background: Globally, neonatal mortality accounts for nearly half of

  under-five mortality, and intrapartum related events are a leading

  cause. Despite the rise in neonatal resuscitation (NR) training programs

  in low-and middle-income countries, their impact on the quality of NR

  skills amongst providers with limited formal medical education,

  particularly those working in rural primary health centers (PHCs),

  remains incompletely understood.

  Methods: This study evaluates the impact of PRONTO International

  simulation training on the quality of NR skills in simulated

  resuscitations and live deliveries in rural PHCs throughout Bihar,

  India. Further, it explores barriers to performance of key NR skills.

  PRONTO training was conducted within CARE India''s AMANAT intervention, a

  maternal and child health quality improvement project. Performance in

  simulations was evaluated using video-recorded assessment simulations at

  weeks 4 and 8 of training. Performance in live deliveries was evaluated

  in real time using a mobile-phone application. Barriers were explored

  through semi-structured interviews with simulation facilitators.

  Results: In total, 1342 nurses participated in PRONTO training and 226

  NR assessment simulations were matched by PHC and evaluated. From week 4

  to 8 of training, proper neck extension, positive pressure ventilation

  (PPV) with chest rise, and assessment of heart rate increased by 14\%,

  19\%, and 12\% respectively (all p <= 0.01). No difference was noted in

  stimulation, suction, proper PPV rate, or time to completion of key

  steps. In 252 live deliveries, identification of non-vigorous neonates,

  use of suction, and use of PPV increased by 21\%, 25\%, and 23\%

  respectively (all p < 0.01) between weeks 1-3 and 4-8. Eighteen

  interviews revealed individual, logistical, and cultural barriers to key

  NR skills.

  Conclusion: PRONTO simulation training had a positive impact on the

  quality of key skills in simulated and live resuscitations throughout

  Bihar. Nevertheless, there is need for ongoing improvement that will

  likely require both further clinical training and addressing barriers

  that go beyond the scope of such training. In settings where clinical

  outcome data is unreliable, data triangulation, the process of

  synthesizing multiple data sources to generate a better-informed

  evaluation, offers a powerful tool for guiding this process.'
affiliation: 'Vail, B (Corresponding Author), Univ Calif San Francisco, Dept Pediat,
  550 16th St,4th Floor,Box 0110, San Francisco, CA 94158 USA.

  Vail, Brennan; Morgan, Melissa C., Univ Calif San Francisco, Dept Pediat, 550 16th
  St,4th Floor,Box 0110, San Francisco, CA 94158 USA.

  Morgan, Melissa C., London Sch Hyg \& Trop Med, Maternal Adolescent Reprod \& Child
  Hlth Ctr, Keppel St, London WC1E 7HT, England.

  Morgan, Melissa C.; Spindler, Hilary; Walker, Dilys M., Univ Calif San Francisco,
  Inst Global Hlth Sci, 550 16th St, San Francisco, CA 94158 USA.

  Christmas, Amelia, PRONTO Int, State RMNCH A Unit, C-16 Krishi Nagar, Patna 80002,
  Bihar, India.

  Cohen, Susanna R., Univ Utah, Coll Nursing, 10 South 2000 East, Salt Lake City,
  UT 84112 USA.

  Walker, Dilys M., Univ Calif San Francisco, Dept Obstet \& Gynecol \& Reprod Serv,
  1001 Potrero Ave, San Francisco, CA 94110 USA.

  Walker, Dilys M., PRONTO Int, 1820 E Thomas St APT 16, Seattle, WA 98112 USA.'
article-number: '291'
author: Vail, Brennan and Morgan, Melissa C. and Spindler, Hilary and Christmas, Amelia
  and Cohen, Susanna R. and Walker, Dilys M.
author-email: brennan.vail@ucsf.edu
author_list:
- family: Vail
  given: Brennan
- family: Morgan
  given: Melissa C.
- family: Spindler
  given: Hilary
- family: Christmas
  given: Amelia
- family: Cohen
  given: Susanna R.
- family: Walker
  given: Dilys M.
da: '2023-09-28'
doi: 10.1186/s12887-018-1254-0
eissn: 1471-2431
files: []
journal: BMC PEDIATRICS
keywords: 'Neonatal resuscitation; Bihar; India; Simulation Training; Barriers to

  Care'
keywords-plus: 'EDUCATIONAL-IMPACT; NEWBORN CARE; MORTALITY; PROGRAM; IMPROVEMENTS;

  DELIVERY; DEATHS'
language: English
month: SEP 3
number-of-cited-references: '37'
orcid-numbers: Medvedev, Melissa/0000-0003-3457-8452
papis_id: bcc33c57c5952e1d6b367fcf1ec29a77
ref: Vail2018powerpractice
times-cited: '18'
title: 'The power of practice: simulation training improving the quality of neonatal
  resuscitation skills in Bihar, India'
type: article
unique-id: WOS:000443426600003
usage-count-last-180-days: '0'
usage-count-since-2013: '6'
volume: '18'
web-of-science-categories: Pediatrics
year: '2018'