Training in obstetric and neonatal emergencies in Mexico: effect on knowledge and self-efficacy by gender, age, shift, and profession.

BACKGROUND: Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts. METHODS: A training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym for Neonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants. RESULTS: After training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average. CONCLUSIONS: Our results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.

[Lead poisoning and marginalization in newborns of Morelos, Mexico]. / Intoxicación por plomo y nivel de marginación en recién nacidos de Morelos, México.

OBJECTIVE:: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). MATERIALS AND METHODS:: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. RESULTS:: The prevalence of Pb poisoning at birth (BLL> 5µg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. CONCLUSION:: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.

Intoxicación por plomo y nivel de marginación en recién nacidos de Morelos, México / Lead poisoning and marginalization in newborns of Morelos, Mexico

Resumen: Objetivo: Determinar la prevalencia de intoxicación por plomo (IPb) al nacimiento en Morelos, analizar su distribución por nivel de marginación y estimar la asociación con el uso de barro vidriado (BV). Material y métodos: Se midió plomo en sangre (PbS) en cordón umbilical de una muestra representativa de 300 nacimientos seleccionados aleatoriamente de aquéllos atendidos por los Servicios de Salud de Morelos e IMSS estatal. Resultados: La prevalencia de IPb al nacimiento (PbS>5µg/dL) fue 14.7% (IC95%: 11.1, 19.3), y 22.2% (IC95%: 14.4, 32.5) en los municipios más marginados. 57.1% (IC95%: 51.3, 62.7) de las madres usaron BV durante el embarazo y la frecuencia de uso se asoció significativamente con PbS. Conclusión: Este es el primer estudio que documenta la proporción de recién nacidos con IPb que están en riesgo de sufrir los consecuentes efectos adversos. Se recomienda monitorear PbS al nacimiento y emprender acciones para reducir esta exposición, especialmente en poblaciones marginadas.

Abstract: Objective: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). Materials and methods: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. Results: The prevalence of Pb poisoning at birth (BLL> 5μg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. Conclusion: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.