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Cycle 1  

Principal Investigator:  Onesmus Gachuno, University of Nairobi
NIH-Supported Collaborator: James Kiarie, University of Nairobi
Title of NIH Award: Linked-Strengthening Maternal, Newborn and Child Health Research Training in Kenya

Gachuno-PRONTO Mod2
Facilitators and participants after completion of PRONTO Module 2 at Kisii Medical Training College, May 2015.(Photo courtesy of Dr. Gachuno)

In Kenya, neonatal mortality accounts for 60% of infant mortality. One third of these deaths are due to intra-partum complications resulting in birth asphyxia which can be prevented by effective interventions. The Government of Kenya has identified inadequate provider competencies in Emergency Obstetric and Neonatal Care (EmONC) as a major challenge to implementation of quality Maternal and Newborn Health (MNH) services and has prioritized improving skilled care and enhancing the capacity of health facilities to provide these services.

In high-resource countries, simulation training has had the greatest success in changing practice and behavior in EmONC particularly in emergency situations however, the models used are expensive, complicated and not conducive for limited-resource settings. PRONTO developed a low-tech highly realistic simulation and team based training specifically for limited-resource settings which has been shown to improve health worker competencies in EmONC and decrease perinatal mortality. This training addresses skill and system barriers to the provision of sustainable quality EmONC thus reducing neonatal and maternal morbidity and mortality.

The overall goal of the proposed study is to evaluate the effectiveness of PRONTO simulation and team training in EmONC in a rural Kenyan setting. Our primary objective is to determine the impact of PRONTO training on 24 hour neonatal mortality in health facilities. Our secondary objectives are to determine the effect of PRONTO training on maternal and neonatal morbidity, health care worker knowledge, skills and practice in EmONC and system change goals achieved by the health facilities.

Using a cluster randomized trial design; we will test the hypothesis that PRONTO training will improve 24 hour neonatal mortality. Participating health facilities in Kisii County will be randomized into two arms: PRONTO training and standard of care. The study population is Kisii health facilities, the workers caring for women during labor and delivery at these health facilities, and their newborns.

Public Health Impact:
PRONTO is a low-tech, high fidelity simulation training that has been shown, in other settings, to improve health care worker skills and knowledge in EmONC and potentially neonatal survival. It is hoped PRONTO training will lead to improved patient care, better patient outcomes and therefore reductions in both neonatal morbidity and mortality in rural Kenya.

NIH Collaborator:
Dr. Kiarie is the lead investigator for the NIH-funded Medical Education Partnership Initiative (MEPI), which aims to to improve the health of Kenyans through research and training.

Summary of Recent Activities

Gachuno-PRONTO Mod1
PRONTO Trainers, Dilys Walker and Salome Mose, debrief participants after a simulation during the PRONTO Module 1 training. (Photo Courtesy of Dr. Gachuno)
In April 2015, PI Dr. Gachuno, M&E Manager, and the Training Coordinator conducted a site visit for the eight intervention health facilities. The training coordinator was able to go through the neonatal resuscitation skills with the clinical officers and nurses on duty during the site visit. Three one-day PRONTO Module 2 trainings were held in May 2015 for health care workers at eight intervention health facility sites and Kisii Teaching and Referral Hospital on PRONTO Simulation and Team-based Emergency Obstetric and Neonatal Care. Kisii Teaching and Referral Hospital is the referring center for the health facilities. A total of 79 health workers from the nine facilities were trained. The research team conducted pre and post training tests and evaluations on knowledge, skills, and attitudes prior to and after the training. Training feedback was also given in written and verbal format and we are in the process of analyzing the feedback to inform future trainings. Each facility developed strategic development goals for implementation in the health facility with the support of the in-charge administrator at the conclusion of the training. These goals were developed based on the PRONTO training and evidence based practices. A stakeholders meeting with the County Health Management Team, In-Charges of the Health Facilities and Local Ministry of Health Personnel was held in May 2015. Preliminary findings of the baseline data collection were presented and included a discussion on the way forward.