title: Improving the knowledge of labour and delivery nurses in India: a randomized controlled trial of mentoring and case sheets in primary care centres.
abstract: Birthing in health facilities in India has increased over the last few years, yet maternal and neonatal mortality rates remain high. Clinical mentoring with case sheets or checklists for nurses is viewed as essential for on-going knowledge transfer, particularly where basic training is inadequate. This paper summarizes a study of the effect of such a programme on staff knowledge and skills in a randomized trial of 295 nurses working in 108 Primary Health Centres (PHCs) in Karnataka, India.
  
  
  
  Stratifying by district, half of the PHCs were randomly assigned to be intervention sites and provided with regular mentoring visits where case sheet/checklists were a central job and teaching aid, and half to be control sites, where no support was provided except provision of case sheets. Nurses' knowledge and skills around normal labour, labour complications and neonate issues were tested before the intervention began and again one year later. Univariate and multivariate analyses were conducted to examine the effect of mentoring and case sheets.
  
  
  
  Overall, on none of the 3 measures, did case sheet use without mentoring add anything to the basic nursing training when controlling for other factors. Only individuals who used both case-sheets and received mentoring scored significantly higher on the normal labour and neonate indices, scoring almost twice as high as those who only used case-sheets. This group was also associated with significantly higher scores on the complications of labour index, with their scores 2.3 times higher on average than the case sheet only control group. Individuals from facilities with 21 or more deliveries in a month tended to fare worse on all 3 indices. There were no differences in outcomes according to district or years of experience.
  
  
  
  This study demonstrates that provision of case sheets or checklists alone is insufficient to improve knowledge and practices. However, on-site mentoring in combination with case sheets can have a demonstrable effect on improving nurse knowledge and skills around essential obstetric and neonatal care in remote rural areas of India. We recommend scaling up of this mentoring model in order to improve staff knowledge and skills and reduce maternal and neonatal mortality in India.
  
  
  
  This study is registered at clinicaltrials.gov, Identifier No. NCT02004912 , November 27, 2013.
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada. jbradley360@shaw.ca.
authors.forename: Janet
authors.initials: J
authors.lastname: Bradley
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.|Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044, India.
authors.forename: Krishnamurthy
authors.initials: K
authors.lastname: Jayanna
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
authors.forename: Souradet
authors.initials: S
authors.lastname: Shaw
authors.affiliation: Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044, India.
authors.forename: Troy
authors.initials: T
authors.lastname: Cunningham
authors.affiliation: IntraHealth, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC, 27517, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fischer
authors.affiliation: St. John's National Academy of Health Sciences, Sarjapur Road, Bangalore, Karnataka State, 560 034, India.
authors.forename: Prem
authors.initials: P
authors.lastname: Mony
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
authors.forename: B M
authors.initials: BM
authors.lastname: Ramesh
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Avery
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
authors.forename: Maryanne
authors.initials: M
authors.lastname: Crockett
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
mesh_terms: D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000193:education*; D005260:Female; D006268:Health Facilities; D006801:Humans; D007194:India; D007231:Infant, Newborn; D000071252:Mentoring; D009740:Nursing Staff / Q000193:education*; D011247:Pregnancy; D011320:Primary Health Care
keywords: Birth checklists; India; Maternal health; Mentoring; Neonatal health; Patient case sheets; Supervision