P438 Design of an assessment tool to evaluate neonatal care practice across a rural province in cambodia and subsequent initiation of a comprehensive neonatal training programme for midwives, nurses and doctors. (June 2019)

• Record Type: Journal Article
• Authors: McGrath, Ailbhe; Smith, Nicola; Prak, Manila; Riedel, Arthur; Sopheak, Neary; Vanna, Dary; Baker, Ele; Gborie, Isata; Leouk, Lorn; Turner, Claudia
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 3
• Page Start: A327
• Page End: A328
• Publication Date: 2019-06
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-epa.774
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction: The neonatal mortality rate (NMR) in Cambodia is 18 per 1000 births. The NMR in rural areas is higher, with a reported rate of 25 per 1000 in the province being studied. A large-scale programme 'The Saving Babies Lives Programme' is currently being piloted to decrease neonatal deaths in Cambodia. An assessment of the current neonatal care practice was necessary to highlight areas for improvement. Our aim was to create an assessment tool to obtain a comprehensive overview of neonatal services to inform the implementation of a sustainable improvement strategy including a comprehensive training programme for midwives, nurses and doctors. Methods: An assessment tool was adapted from the KAP survey model (Knowledge, Attitudes and Practice). Two further sections were added; Equipment and Staffing, forming a 'KAPES survey'. Tablet-based questionnaires were created using KoboCollect Toolbox. Surveys were written in English and translated into Khmer. National and international guidelines and teaching materials were reviewed to decide core teaching topics and the level of care to be provided at each facility. The research team were trained as instructors and mentors. Results: Knowledge and attitude questions were developed across key domains depending on staff member (midwife, nurse or doctor) in the format of multiple choice questions (MCQs) and statements with a Likert scale. Practice, Equipment and Staffing (PES) included multiple question types and were adapted specific to location (health centre/hospital). Surveys were undertaken across 45 health centres and 1 hospital. Although knowledge rates were acceptable, attitudes continuously fell into indifferent or negative ranges in certain domains. A multiple tiered neonatal training programme was developed, depending on staff type (midwife, nurse or doctor) comprising of a classroom-based residential component, shadowing at a tertiary neonatal facility and an extensive mentorship period. Teaching materials, assessments and logbooks were prepared, tailored to conditions commonly encountered and resources available locally, written in English and translated into Khmer. Where resources were deficient, plans to supply equipment were initiated. Development of a neonatal care unit was commenced. Conclusions: An assessment tool called a 'KAPES survey' was created to comprehensively assess neonatal services in rural Cambodia. A comprehensive multiple-tier neonatal training programme was developed and adapted to specific needs. Initial data guided implementation of the strategy to decrease the NMR. Repeating the survey will evaluate progress of the intervention. Ultimately, this tool and programme could be replicated across the country and may be useful in other middle to low-income countries.