Validation of a novel tool for assessing newborn resuscitation skills among birth attendants trained by the Helping Babies Breathe program.
OBJECTIVE
To validate a simplified objective structured clinical examination (OSCE) tool for evaluating the competency of birth attendants in low-resource countries who have been trained in neonatal resuscitation by the Helping Babies Breathe (HBB) program.


METHODS
A prospective cross-sectional study of the OSCE tool was conducted among trained birth attendants working at dispensaries, health centers, or hospitals in five regions of Tanzania between October 1, 2013, and May 1, 2014. A 13-item checklist was used to assess clinical competency in a simulated newborn resuscitation scenario. The OSCE tool was simultaneously administered by HBB trainers and experienced external evaluators. Paired results were compared using the Cohen κ value to measure inter-rater reliability. Participant performance was rated by health cadre, region, and facility type.


RESULTS
Inter-rater reliability was moderate (κ = 0.41-0.60) or substantial (κ = 0.61-0.80) for eight of the OSCE items; agreement was fair (κ = 0.21-0.41) for the remaining five items. The best OSCE performances were recorded among nurses and providers from facilities with high annual birth volumes.


CONCLUSIONS
The simplified OSCE tool could facilitate efficient implementation of national-level HBB programs. Limitations in inter-rater reliability might be improved through additional training.
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Electronic address: reisman.jonathan@gmail.com.
Jonathan
J
Reisman
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
Narra
N
Martineau
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
Allan
A
Kairuki
Jhpiego, Dar es Salaam, Tanzania.
Victor
V
Mponzi
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Muhimbili National Hospital, Dar es Salaam, Tanzania.
Amunga R
AR
Meda
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Triangle Solutions, Dar es Salaam, Tanzania.
Kahabi G
KG
Isangula
Jhpiego, Dar es Salaam, Tanzania.
Erica
E
Thomas
Jhpiego, Dar es Salaam, Tanzania.
Marya
M
Plotkin
Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA, USA.
Grace J
GJ
Chan
The Children's Investment Fund Foundation, London, UK.
Leila
L
Davids
Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
Georgina
G
Msemo
Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
Mary
M
Azayo
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Brett D
BD
Nelson
D001238:Asphyxia Neonatorum / Q000628:therapy*; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000193:education*; D015588:Observer Variation; D015397:Program Evaluation / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012151:Resuscitation / Q000193:education*; D013636:Tanzania
Birth asphyxia; Inter-rater reliability; Intrapartum-related complications; Low-income countries; Neonatal resuscitation; Newborn care; Objective structured clinical examination