O2069: Extended Benefits of Innovative Virtual Training and Support for Neonatal Resuscitation Education to Midwives in Rohingya Refugee Camps of Cox’s Bazar, Bangladesh

Background: The COVID-19 pandemic encouraged innovative education methods, by adapting clinical educational resources for remote delivery. Historically taught in-person, Helping Babies Breathe (HBB) is a well-established newborn resuscitation education program. Essential Newborn Care Now! (ENC Now!) was developed by the American Academy of Pediatrics (AAP) and Laerdal Global Health to teach the World Health Organization’s (WHO) Essential Newborn Care (ENC) course, which is heavily grounded in HBB, thereby creating a digital training package for remote facilitation. Using high-fidelity mannequins and digital assessment tools combined with low-dose, high-frequency (LDHF) skills practice, the program aims to reduce newborn mortality rates in resource-limited settings using local and/or remote facilitators. The AAP in collaboration with MedGlobal, RTMI, & Hope Foundation, piloted ENC Now! in Cox's Bazar, to evaluate the impact of the novel platform and virtual education on pre- and post-training knowledge and skills of midwives serving in the Rohingya refugee camp.

Methods: A remote global mentor supported Bangladeshi facilitators in the Rohingya camp over 2 days, blending online and in-person didactic and skills training using web platforms and NeoNatalie Live (NNL) manikins to train 30 midwives selected from 13 birthing facilities serving refugees. The Bangladeshi facilitators then conducted 4 days of LDHF live practice sessions on NNL built-in case scenarios. A chat group was created to provide remote mentorship where learners could trouble-shoot skills challenges. Evaluation included pre/post training and endline (6 months later) knowledge and skills assessments using NNL and feedback provided to participants. Qualitative feedback was obtained via focused group discussions (FGD).

Results: Average scores on knowledge tests increased from 70% (N=26, range 25-80%) at baseline to 98% (90-100%) at endline. NNL data indicated average scores on ventilation skills increased from 43% (7-86%) to 100% (100%), and at endline ventilation rate averaged 44 breaths/min with 92% effective ventilations, and 90% participants passed endline clinical scenarios. Endline FGD indicated all the participants (18/18) interviewed reported the training and LDHF practice significantly improved their ability to care for babies at birth, with the ability to make babies cry within one minute as their greatest success. Many of the midwives reported there had been no skilled neonatal service provider in their facility before the training, and their only prior neonatal resuscitation training was didactic, so they shared their learning with colleagues. Other observed effects included increasing education accessibility, decolonizing resuscitation education and reducing carbon footprint by decreasing international travel.

Conclusion: Blended learning using ENC Now! improves skills and confidence in early initiation of resuscitation of newborns in a humanitarian setting. Participants retained skills using digital tools and LDHF practice. Training with remote facilitation increased the reach of neonatal resuscitation training, supported local facilitators to lead the trainings, and reduced our carbon footprint.