Effect of Training on the Knowledge of Health Care Workers in the Assessment of Neonatal Hypoxic-ischemic Encephalopathy at the Kenyatta National Hospital- a Quasi-experimental Study

Abstract

Background: Neonatal encephalopathy describes neonates (born at 35 weeks gestation or beyond) displaying subnormal level of consciousness or seizures which may be accompanied by difficulty initiating and maintain respiration and abnormal tone and reflexes. 50-80% of neonatal encephalopathy is attributed to hypoxic-ischemic encephalopathy that has many complications such as cerebral palsy. Good knowledge and proper assessment are therefore important for timely intervention using proven neuroprotective measures (therapeutic hypothermia) alongside supportive treatment. Objective: To determine the effect of training healthcare workers on their knowledge of the assessment of neonatal hypoxic-ischemic encephalopathy at the Kenyatta National Hospital’s newborn unit. Study design and setting: A quasi-experimental study design conducted at the Kenyatta National Hospital’s newborn unit. Intervention- 15 minutes power point training with content derived from the 2018 Kenyan newborn guidelines on neonatal hypoxic ischemia. Methodology: Census method was employed and demographic and knowledge scores (before and after training) collected using a validated 25 structured questionnaire. Knowledge on the diagnosis, neurological assessment and treatment of HIE was tested. A score above 60% was considered good. Data analysis: Descriptive and inferential analysis was done. A chi-square test assessed the association between categorical variables in the study. McNemar's test assessed the difference in assessment performance (pass/fail). A paired t-test was also used to compare the knowledge scores pre-training and post-training. Multiple linear regression was used to assess factors associated with the knowledge level of HCWs in assessment of HIE. Statistical significance was evaluated at 0.05 significance level. Results: 85 participants were enrolled of whom 69 were nurses,10 paediatric residents. 4 medical officers and 2consultants. Overall knowledge scores improved significantly after the training, p-values <0.001 and in some specific areas p values <0.001namely; the definition of neonatal encephalopathy, appropriate post resuscitation management for a newly born baby with suspected HIE, and grading score systems used in HIE. Prior training was significantly associated with knowledge score, OR 0.23 (0.09, 0.59), p-value 0.02. Cadre and years of experience were not associated with knowledge scores, p-values >0.05. Conclusion: There was a statistically significant improvement in the overall knowledge scores after training. Previous training was statistically significantly associated with good knowledge scores. Recommendations: Continuous training of healthcare workers to improve their knowledge and performance in the care of patients and multisite studies of the same type to allow generalizability. Utility: The impact of training on healthcare workers' knowledge levels on HIE assessment and management was determined, problem areas identified and hence useful in enhancing efficacy and change processe