P0255 - eHBB: A randomized controlled trial of virtual reality for newborn resuscitation refresher training of healthcare workers in Nigeria and Kenya

Background: Each year, there are 2.8 million newborn deaths, most of which are preventable. Intrapartum asphyxia is one of the three leading causes of neonatal mortality. In 2017, poor quality of care accounted for almost 1 million neonatal deaths, mostly during the intrapartum period. As the majority of these deaths occur in low- and middle-income country settings where there is high penetrance of mobile devices, we hypothesized that mobile virtual reality (VR) simulation refresher training in neonatal resuscitation (NR) would support the maintenance of HCW NR skills over time.

Methods: Healthcare workers who work in labor and delivery and newborn care units at secondary and tertiary healthcare facilities in Lagos, Nigeria and Busia, Western Kenya and who had not received training in Helping Babies Breathe in the past one year were recruited to participate in the study. Participants were consented and randomized to receive the eHBB VR + digital manual, NR video + digital manual or control (digital manual only) interventions. Participants were asked to review their assigned digital intervention weekly and perform manikin-based practice at a HBB corner. Follow-up assessments were conducted by trained research assistants using the HBB 2nd edition bag-and-mask (BMV) skills, OSCE A and OSCE B digital checklists on the mHBS/DHIS2 application immediately post-course and at 1-month, 3-month and 6-month follow-up. The Neonatalie Advanced manikin was used for standardized data collection. Kruskal-Wallace test or Wilcoxon rank-test test comparing scores between groups and Fisher’s exact test was used for comparing pass rates between groups with no adjustment for multiple comparisons.

Results: A total of 274 HCWs participated. See Table 1. Pass rates and scores were similar across groups at the pre-course and immediate post-course periods. Pass rates for BMV skills decreased over the 6-month follow-up period across all groups although the change was less in the VR group (-20% VR, p<0.05; -22% video, p<0.01, -28% control, p=0.001). Figure 1. The pass rates on OSCE A were sustained across groups (6-month pass rates 77% VR, 75% video, 71% control, p=0.73). Compared to the other groups, OSCE B pass rates were more stable in the VR group (58% immediate post-class, 63%, 3-month, 61% 6-month). The video group showed the most significant decrease in OSCE B pass-rates over the 6-month follow-up period (delta -16%, video, p<0.05).

Conclusion: Mobile VR for refresher training may support NR skills maintenance in HBB trained HCWs in low and middle income countries. HCWs in the VR group had sustained pass rates on advanced assessments of simulated neonatal resuscitation skills over the 6-month study follow-up period.

Acknowledgements: This project was supported by the Bill and Melinda Gates Foundation.