title: Strategic assessment of implementation of neonatal resuscitation training at a national level.
abstract: BACKGROUND
  Structuring and implementation of an endorsed neonatal resuscitation program (NRP) results in decreased neonatal mortality. This study evaluated the implementation of formal training using the NRP in a private sector context of a middle income country.
  
  
  METHODS
  Between 2008 and 2011, the National Collaborative Perinatal Neonatal Network (NCPNN) supported by the Ministry of Health piloted the implementation of NRP training in member hospitals throughout the country. Training of trainers (TOT) then providers (TOP) took place via workshops where a lecture was given followed by hands-on training using low-fidelity manikins. Pre- and post-workshop knowledge assessment and hands-on training evaluation were done. t-test and one-way ANOVA were used to compare mean differences in pre- and post-workshop scores and percent improvement across specialties and locations.
  
  
  RESULTS
  Of 20 TOT participants, nine (45%) conducted NRP in their hospitals. Ten TOP workshops included 256 professionals. The majority were doctors (128, 50%), followed by nurses (99, 39%) and midwives (20, 8%). Overall pre-training scores (67.25 ± 16.00%) were significantly lower than post-training scores (87.48 ± 11.89%; P = 0.000); percent improvement among all participants was 37.12 ± 41.15%; P = 0.82). Nurses and participants from the northern governorate had highest mean difference in before/after scores (21.56 ± 12.32 and 23.29 ± 6.62, respectively). Midwives had the highest percent improvement (40.44 ± 47.28). All but 25 participants (9.8%) passed the megacode at the first attempt.
  
  
  CONCLUSIONS
  Implementing NRP training is essential to increase the knowledge and skills of health-care professionals. It is sustainable with support from the Ministry and other sources. Continuing education should be mandated at the Ministry of Health level.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.|National Collaborative Perinatal Neonatal Network, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Lama
authors.initials: L
authors.lastname: Charafeddine
authors.affiliation: National Collaborative Perinatal Neonatal Network, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Maya
authors.initials: M
authors.lastname: Badran
authors.affiliation: National Collaborative Perinatal Neonatal Network, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Pascale
authors.initials: P
authors.lastname: Nakad
authors.affiliation: Ministry of Public Health of Lebanon, Beirut, Lebanon.
authors.forename: Walid
authors.initials: W
authors.lastname: Ammar
authors.affiliation: Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.|National Collaborative Perinatal Neonatal Network, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Khalid
authors.initials: K
authors.lastname: Yunis
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004521:Educational Measurement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008348:Manikins; D008880:Midwifery / Q000193:education*; D009359:Neonatology / Q000193:education*; D012151:Resuscitation / Q000193:education*; D012189:Retrospective Studies
keywords: middle income country; neonatal resuscitation; program implementation; simulation; training