title: Assessing the capacity for newborn resuscitation and factors associated with providers' knowledge and skills: a cross-sectional study in Afghanistan.
abstract: BACKGROUND
  Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in resource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering comprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility characteristics associated with providers' knowledge and clinical skills.
  
  
  METHODS
  Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn resuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and infrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses were performed using STATA 11.2 and SAS 9.1.3.
  
  
  RESULTS
  Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag, and mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely than doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No significant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in performing newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge questions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in their ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and clinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience offering EmONC services.
  
  
  CONCLUSIONS
  Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan, but providers' knowledge and skills need strengthening in some areas. Midwives proved to be as capable as doctors of performing newborn resuscitation, which validates the major investment made in midwifery education. Competency-based pre-service and in-service training, complemented by supportive supervision, is an effective way to build providers' capacity to perform newborn resuscitation. This kind of training could also help skilled birth attendants based in the community, at private clinics, or at primary care facilities save the lives of newborns.
authors.affiliation: Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA. Young-Mi.Kim@jhpiego.org.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Kim
authors.forename: Nasratullah
authors.initials: N
authors.lastname: Ansari
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kols
authors.forename: Hannah
authors.initials: H
authors.lastname: Tappis
authors.forename: Sheena
authors.initials: S
authors.lastname: Currie
authors.forename: Partamin
authors.initials: P
authors.lastname: Zainullah
authors.forename: Patricia
authors.initials: P
authors.lastname: Bailey
authors.forename: Richard
authors.initials: R
authors.lastname: Semba
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: Jelle
authors.initials: J
authors.lastname: Stekelenburg
mesh_terms: D000328:Adult; D000346:Afghanistan; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006771:Hospitals, Maternity / Q000592:standards*; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D008880:Midwifery / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012151:Resuscitation / Q000193:education*; D000078329:Workforce
references.citation: Paediatr Perinat Epidemiol. 2012 Sep;26(5):388-97
references.pmid: 22882783
references.citation: Health Policy Plan. 2012 Jul;27 Suppl 3:iii6-28
references.pmid: 22692417
references.citation: Hum Resour Health. 2012 Jul 09;10:13
references.pmid: 22776289
references.citation: Public Health. 2008 Jun;122(6):558-67
references.pmid: 18460411
references.citation: Lancet. 2012 Mar 31;379(9822):1193; author reply 1194-5
references.pmid: 22464377
references.citation: Int J Gynaecol Obstet. 2009 Oct;107 Suppl 1:S47-62, S63-4
references.pmid: 19815203
references.citation: J Paediatr Child Health. 2011 Mar;47(3):83-6
references.pmid: 21091578
references.citation: Semin Perinatol. 2010 Dec;34(6):395-407
references.pmid: 21094414
references.citation: BMC Public Health. 2011 Apr 13;11 Suppl 3:S12
references.pmid: 21501429
references.citation: Int J Gynaecol Obstet. 2012 Mar;116(3):192-6
references.pmid: 22196990
references.citation: BMC Pediatr. 2012 Oct 05;12:159
references.pmid: 23039709
references.citation: Pan Afr Med J. 2012;11:78
references.pmid: 22655112
references.citation: Lancet. 2010 Dec 4;376(9756):1923-58
references.pmid: 21112623
references.citation: Hum Resour Health. 2009 Apr 24;7:36
references.pmid: 19393073
references.citation: Hum Resour Health. 2004 Jun 22;2(1):8
references.pmid: 15212695
references.citation: Semin Perinatol. 2010 Dec;34(6):371-86
references.pmid: 21094412
references.citation: Pan Afr Med J. 2012;11:45
references.pmid: 22593781
references.citation: Ethiop Med J. 2012 Jan;50(1):43-55
references.pmid: 22519161
references.citation: Midwifery. 2011 Aug;27(4):399-408
references.pmid: 21601321