title: Evaluation of a novel training package among frontline maternal, newborn, and child health workers in South Sudan.
abstract: OBJECTIVE
  To develop, implement, and evaluate an evidence-based Maternal, Newborn, and Child Survival (MNCS) package for frontline health workers (FHWs) in South Sudan.
  
  
  METHODS
  A multimodal needs assessment was conducted to develop a best-evidence package comprised of targeted training, pictorial checklists, and reusable equipment and commodities. Implementation utilized a training-of-trainers model. Program effectiveness was assessed through knowledge assessments, objective structured clinical examinations (OSCEs), focus groups, and questionnaires.
  
  
  RESULTS
  A total of 72 trainers and 708 FHWs were trained in 7 South Sudan states. Trainer knowledge assessments improved significantly: from 62.7% to 92.0% (P<0.001). Mean FHW scores on maternal OSCEs were 21.1% pre-training, 83.4% post-training, and 61.5% 2-3 months after training (P<0.001). Corresponding mean newborn OSCE scores were 41.6%, 89.8%, and 45.7% (P<0.001). Questionnaires revealed high levels of use, satisfaction, and confidence. FHWs reported an average of 3.0 referrals (range, 0-20) to healthcare facilities during the 2-3 months following training, and 78.3% of FHWs were more likely to refer patients. Seven focus groups showed high satisfaction with trainings, commodities, and checklists, with few barriers.
  
  
  CONCLUSIONS
  The MNCS package has led to improved FHW knowledge, skills, and referral. A novel package of training, checklists, and equipment can be successfully implemented in resource-limited settings and enhance links between community-based providers and healthcare facilities.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. brett.d.nelson@gmail.com
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.forename: Maya
authors.initials: M
authors.lastname: Fehling
authors.forename: Melody J
authors.initials: MJ
authors.lastname: Eckardt
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Conn
authors.forename: Alaa
authors.initials: A
authors.lastname: El-Bashir
authors.forename: Margaret
authors.initials: M
authors.lastname: Tiernan
authors.forename: Genevieve
authors.initials: G
authors.lastname: Purcell
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D057189:Checklist; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002983:Clinical Competence; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013397:Sudan; D011795:Surveys and Questionnaires