Simulation-Based Training in Emergency Obstetric Care in Sub-Saharan and Central Africa: A Scoping Review.

Background: Every day approximately 810 women die from complications related to pregnancy and childbirth worldwide. Around two thirds of these deaths happen in sub-Saharan Africa. One of the strategies to decrease these numbers is improving the quality of care by emergency obstetric simulation-based training. The effectiveness of such training programs depends on the program's instructional design. Objective: This review gives an overview of studies about emergency obstetric simulation-based training and examines the applied instructional design of the training programs in sub-Saharan and Central Africa. Methods: We searched Medline, Embase and Cochrane Library from inception to May 2021. Peer-reviewed articles on emergency obstetric, postgraduate, simulation-based training in sub-Saharan and Central Africa were included. Outcome measures were categorized based on Kirkpatrick's levels of training evaluation. The instructional design was evaluated by using the ID-SIM questionnaire. Findings: In total, 47 studies met the inclusion criteria. Evaluation on Kirkpatrick level 1 showed positive reactions in 18 studies. Challenges and recommendations were considered. Results on knowledge, skills, and predictors for these results (Kirkpatrick level 2) were described in 29 studies. Retention as well as decay of knowledge and skills over time were presented. Results at Kirkpatrick level 3 were measured in 12 studies of which seven studies demonstrated improvements of skills on-the-job. Improvements of maternal and neonatal outcomes were described in fifteen studies and three studies reported on cost-estimations for training rollout (Kirkpatrick level 4). Instructional design items were heterogeneously applied and described. Conclusions: Results of 47 studies indicate evidence that simulation-based training in sub-Saharan and Central Africa can have a positive impact across all four levels of Kirkpatrick's training evaluation model. However, results were not consistent across all studies and the effects vary over time. A detailed description of instructional design features in future publications on simulation-based training will contribute to a deeper understanding of the underlying mechanisms that determine why certain training programs are more effective in improving maternal and neonatal healthcare outcomes than other.

The use of a stronger instructional design by implementing repetitive practice in simulation-based obstetric team training: trainees' satisfaction.

Objective: This study compares satisfaction levels from multiprofessional obstetric care teams about simulation-based obstetric team training courses with and without the instructional design feature repetitive practice. Methods: The present study is part of a multicentre cluster-randomised controlled trial (TOSTI trial) that investigated the effectiveness of a 1 day, multiprofessional, simulation-based obstetric team training. The initial training group received a training which was designed based on best practice. After 1 year, the control group received a training course in which the instructional design was changed by providing repetitive practice. All participants were asked to fill in a 29-item evaluation form with seven questions about baseline characteristics and 22 questions about training features. The questions about training features could be rated on a scale of 1 to 5. Finally, all participants were asked to rate the total training day on a scale of 1-10. Results: The best practice group consisted of 471 trainees and the repetitive practice group of 549, including gynaecologists, residents, midwives and nurses. The best practice group rated the total training day significantly higher than the repetitive practice group (mean 8.8, SD 0.6 and mean 8.7, SD 0.6; p<0.003, Cohen's d=0.19). Several training features were also scored higher in the best practice group. Conclusion: This study showed that obstetric healthcare professionals rated a simulation-based obstetric team training course, with and without repetition of scenarios, both high. The training without the repetitive elements gained higher scores for the total training dayand several, and several training features were scored higher. The difference between the mean scores and the effect sizes for the training features were small. This implies that repetitive practice can be integrated in simulation-based team training to optimise learning effects, with small effects on trainees satisfaction.

Risk factors of incomplete Apgar score and umbilical cord blood gas analysis: a retrospective observational study.

OBJECTIVE: To investigate whether incomplete umbilical cord blood gas (UCBG) analysis occurs more often than the incomplete reporting of the Apgar score, and risk factors associated with the incomplete values. METHODS: A total of 8824 infants born alive after 26 weeks' gestation between January 2009 and April 2013 were included. We extracted data on five-minute Apgar score, UCBG analysis, gestational age, mode of delivery, time of delivery and multiple pregnancy. Univariate and multivariable logistic regression analyses were performed. RESULTS: Five-minute Apgar score was incomplete in 15 cases (0.2%) and UCBG analysis in 1960 cases (22.2%), p < 0.05. Incomplete UCBG analysis was significantly more likely to occur in situations with Apgar score below seven (Odds ratio (OR) 1.68, 95% CI;1.29-2.19), gestational age between 26 to 27 6/7 and 28 to 31 6/7 weeks (OR 3.14, 95% CI; 2.13-4.62 and OR 1.91, 95% CI; 1.57-2.32), cesarean section (OR 1.31, 95% CI; 1.11-1.55), and multiple pregnancy (OR 2.02, 95% CI; 1.69-2.43). Deliveries during night time had a lower risk of incomplete UCBG analysis (OR 0.78, 95% CI; 0.69-0.88). CONCLUSIONS: Measuring five-minute Apgar score generated less incomplete data compared with UCBG analysis. The risk factors associated with incomplete UCBG analysis were noted. Study outcomes with UCBG analysis as neonatal assessment tool should be interpreted with caution.