Evaluating a novel neonatal-care assessment tool among trained delivery attendants in a resource-limited setting.
OBJECTIVE
To validate a novel objective structured clinical examination (OSCE) tool for assessing neonatal care skills among delivery attendants trained as part of the Essential Care for Every Baby (ECEB) program and to assess ECEB training effectiveness.


METHODS
Between August 1 and September 30, 2015, a cross-sectional study enrolled ECEB-trained healthcare providers who attended deliveries from the Brong Ahafo and Eastern regions of Ghana. Participants completed a previously developed 21-item OSCE tool that assessed neonatal-care competency. Participant performance was scored independently by regional trainers and national master trainers. The inter-rater scoring reliability was assessed using the Cohen kappa coefficient and performance was compared across participant characteristics.


RESULTS
The study enrolled 57 trained delivery attendants from 12 district hospitals. Inter-rater agreement was perfect (kappa 1.00) or almost perfect (kappa 0.81-0.99) for nine OSCE items, substantial (kappa 0.61-0.80) or moderate (kappa 0.41-0.60) for 11 items, and fair (kappa 0.21-0.40) for one item. Differences in OSCE-item performance were recorded based on participants' regions, facility type, age, and education level (P<0.05).


CONCLUSIONS
In a resource-limited setting, the OSCE tool demonstrated substantial reliability and ECEB-trained healthcare practitioners exhibited satisfactory performance. The OSCE tool could be useful in similar settings and could have potential for up-scaled use in assessing neonatal-management skills.
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Megan E
ME
Kassick
PATH, Accra, Ghana.
Margaret A
MA
Chinbuah
PATH, Accra, Ghana.
Magdalena
M
Serpa
PATH, Accra, Ghana.
Goldy
G
Mazia
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Alice M
AM
Tang
Ghana Health Service, Accra, Ghana.
Isabella
I
Sagoe-Moses
Ghana Health Service, Accra, Ghana.
Mira
M
Taylor
Ghana Health Service, Accra, Ghana.
Adoma
A
Dwomo-Fokuo
Ghana Health Service, Accra, Ghana.
Nihad
N
Salifu
Noguchi Memorial Institute for Medical Research, Accra, Ghana.
Daniel K
DK
Arhinful
PATH, Accra, Ghana; Division of Neonatal Perinatal Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.
Cyril
C
Engmann
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Thomas F
TF
Burke
PATH, Accra, Ghana.
Patience
P
Cofie
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: brett.d.nelson@gmail.com.
Brett D
BD
Nelson
D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D006282:Health Personnel / Q000193:education*; D006761:Hospitals; D006801:Humans; D007223:Infant; D000068104:Infant Health / Q000592:standards*; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000592:standards*; D011295:Prenatal Care / Q000592:standards*; D015203:Reproducibility of Results; D055815:Young Adult
Birth attendant; Essential care for every baby; Essential newborn care; Ghana; Inter-rater reliability; Neonatal mortality; Newborn health; Objective structured clinical examination