SM
Breathe
Helping Babies
Improves Resuscitation Skills in Kenya and Pakistan
William Keenan, St Louis University, St Louis, MO USA
Maqbool Qadir, Aga Khan University, Karachi, Pakistan
Sherri Bucher, Indiana University / Moi University Kenya Partnership, Eldoret, Kenya
Global Implementation Task Force, American Academy of Pediatrics, Elk Grove Village, IL USA
SETTING
BACKGROUND
Field trials took place in rural districts of Kenya and Pakistan in 2009.
 Annually, over 40% of mortality in children under 5 years
OBJECTIVES
 Conduct formative evaluation of Helping Babies
Breathe educational methodology, materials, and
assessment tools.
occurs during the neonatal period (0 – 28 days after birth).
 Reducing neonatal death will help achieve Millennium
 Ascertain satisfaction, self-efficacy, knowledge
Development Goal #4: Reduce under-5 child mortality by 2/3 by
2015.
and skills among facilitators and learners after
training in Helping Babies Breathe.
 Birth asphyxia underlies approximately one quarter of all
neonatal deaths.
 Utilize evaluation data to formulate course
 Helping Babies Breathe (HBB) is a skills-based educational
revisions.
program, developed by the American Academy of Pediatrics and
multiple organizational partners, which aims to reduce mortality
by training birth attendants in neonatal assessment and
resuscitation.
METHODS and MATERIALS
Design: Pilot studies evaluated HBB materials and participants using quantitative and qualitative methods:
• surveys of satisfaction and self-efficacy
• multiple choice questions (MCQ)
• bag/mask skills evaluation
• objective structured clinical evaluations (OSCE)
• focus groups
Population: Birth attendants from western Kenya and Pakistan represented pediatricians, OB/GYNs, nurses,
midwives, community birth attendants, and lady health volunteers.
Materials: Water-filled neonatal simulator with crying, breathing, and heart rate functions (Laerdal Medical);
250 mL self-inflating bag; preterm/term newborn masks; Learner Workbook, Action Plan, and Facilitator Flip
Chart (all in English).
Procedures: A train-the-trainer model included Facilitators (N=20 Kenya, 11 Pakistan), and Learners (N=48
Kenya , 54 Pakistan). Facilitators and learners completed evaluations after being taught and facilitators also
completed evaluations of the teaching experience.
Analysis: Descriptive statistics summarized the responses to evaluation surveys. Assessment scores were
compared pre- and post program (Student’s t-test for paired samples) and/or compared to anticipated scores
for successful completion. Qualitative data are reported separately.
HBB Facilitator Flip Chart and Learner Workbook
Laerdal Neonatal Simulator
RESULTS
Facilitator Performance of Bag/Mask
Score (12 Max)
12
10.5
10
8
6
4
2.4
2
0
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Learner Performance of Bag/Mask
12
Score (12 Max)
HBB educational methodology, materials, assessment tools
 Facilitators and learners rated the program’s learning methodology, content, and materials highly.
Positives: Functionality of neonatal simulator
Suggestions: Additional time for skills practice
Concept of The Golden MinuteSM
Video demonstration of skills and assessments
Graphic linkage among materials
Larger illustrations in print materials
Translation of print materials into local languages
 Assessment scores of knowledge, skills, and performance were lower than expected, suggesting shortcomings in the structure and
presentation of assessments.
Positives: Concordant scores on knowledge
Suggestions: Single-answer (not 2-answer) MCQs
and skills assessments post training
Grouping of items on skills checklists
Increased emphasis on skills and assessment of bag/mask ventilation
Participant satisfaction and self-efficacy
 Facilitators and learners expressed high satisfaction with teaching and learning experiences.
 Facilitators expressed self-efficacy in teaching and learners expressed self-efficacy in performing resuscitation.
Facilitator and learner knowledge and skills
 Pre-testing in Kenya showed better scores on knowledge assessments as compared to skills performance.
• Knowledge and skills became concordant post-training.
 Learners showed a significant increase in knowledge and skills of bag and mask ventilation post-training.
• Learners had difficulty maintaining mask seal, achieving target ventilation rate, and assessing chest rise.
 Scores on skills assessments were lower than anticipated levels for successful completion.
• Shortcomings of assessment tools lowered overall scores.
• Learners require additional practice to achieve mastery of skills.
9.4
10
8
6
4
2
0.2
0
Kenya Pre
PAKISTAN
CONCLUSIONS and REVISIONS BASED ON FORMATIVE EVALUATION
HBB materials, equipment, and training concepts were well accepted and promoted learning.
Revisions: Linkages among pictorial materials, practice with the neonatal simulator, and the concept of The Golden Minute were further reinforced.
Written/verbal evaluation format was simplified, and skill exercises were strengthened to provide more practice and promote mastery of bag/mask ventilation.
Images were enlarged and print formats were revised for increased clarity.
HBB training resulted in self-efficacy in teaching and performance of resuscitation.
Revisions: Additional training and evaluation will be conducted among community-based birth attendants using translated materials.
HBB increased knowledge and skills; however, mastery of bag and mask ventilation requires additional practice.
Revisions: Expectations for mastery of bag and mask ventilation were clearly articulated; performance checklists were reduced in length by grouping steps.
Additional opportunities for practice and learning beyond the classroom were added (supervised clinical practice, self-reflective learning, case review).
Course formats of 1 or 2 days will be compared for learner satisfaction and performance outcomes, as will courses incorporating video.
ACKNOWLEDGEMENTS
Professor Fabian Esamai, Moi Unviersity School of Medicine, co-Principal Investigator , Kenya. Dr. Peter Gisore (MUSOM) and Dr. Ed Liechty (IUSOM), co-Investigators, Kenya. Dr Zulfiqar Bhutta, Aga Khan University, co-Investigator, Pakistan
The American Academy of Pediatrics provided funding for field testing. Jocelyn Lockyer, PhD, University of Calgary provided analytical and statistical support. Laerdal Foundation for Acute Medicine provided neonatal simulators and equipment.
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