Implementation and evaluation of a neonatal educational program in rural Nepal

A needs assessment at Tansen Mission Hospital established gaps in knowledge, skills and attitudes of health professionals, contributing to the high neonatal mortality in Nepal. This study was designed to implement and evaluate the effectiveness of an educational program in Newborn Care, using best evidence teaching methods and content. Pre intervention, an audit of newborn care practices and documentation was performed using a structured checklist. Intervention consisted of four teaching sessions each involving short lectures and interactive skills stations. Post intervention, participant satisfaction, knowledge, competence and performance were evaluated. In 80 per cent of responses (n=30), participants evaluated the program as very good or excellent. Matched pair pre and post education MCQ scores compared knowledge, with significant improvement in all groups (nurses, doctors and community health workers). Competence was evaluated by an Objective Structured Clinical Examination with mean scores (+/-SD) ranging from 65 per cent (7.0) to 87 per cent (7.3). Performance was examined by pre and post-intervention audit of records. Significant changes in practice included a 100 per cent increase in measuring length and head circumference, charting percentiles and documentation of structured history and examination in the Newborn Care Notes. Administration of vitamin K at birth increased by 71 per cent, assessment of hypoglycaemia risk by 94 per cent and those at risk of hypoglycaemia having a blood sugar level measured increased by 58 per cent. These results led to consideration of appointment of a postgraduate educator. Even with limitations in educating and implementing change in a resource limited rural setting, a short, interactive education program can have positive educational outcomes and can change practice. Sustainability is dependent on staff employing continuing education.