Health worker training and day-1 feeding prescriptions for very low birth weight neonates: an interrupted time series study in two Kenyan hospitals

Abstract

Background Optimal nutrition in very low birth weight (VLBW) neonates is essential in decreasing mortality and long-term morbidities but remains suboptimal in many newborn units (NBUs) in resource-limited settings. We assessed the effect of training healthcare practitioners (HCPs) on feeding prescriptions on the first day of life of VLBW neonates in two Kenyan newborn units. Methods We conducted a quasi-experimental study using an interrupted time series (ITS) design. The intervention was HCP training on feeding of VLBW neonates. We extracted data on feed prescriptions issued on day one of life for all VLBW neonates admitted to the two newborn units. We calculated the proportion of correct feed prescriptions at different time points in the pre-interventional and post-interventional periods, and modelled changes using segmented beta regression. Results We analyzed feed prescriptions for 181 and 254 neonates in the pre-intervention and post-intervention periods, respectively. The proportion of correct prescriptions increased from 38.1% to 45.3%, corresponding to an absolute effect (effect size) of 7.2 percentage points (95% CI −2.7–17.0). Segmented ITS analysis showed a declining pre-intervention trend in prescription correctness followed by an immediate step increase after the training. However, the improvement plateaued from the second month post-intervention. Neonatal stability, referral status, and place of admission were independently associated with incorrect feed prescriptions ( p < 0.001, p = 0.008, and p = 0.007, respectively). Conclusions A short, focused training intervention was associated with a modest, overall non-significant increase in the correctness of day-1 feeding prescriptions for VLBW neonates. ITS analysis suggested a possible early post-training improvement, but the segmented regression estimates were not statistically significant, and there was no evidence of a sustained effect over time. These findings suggest that training alone may be insufficient to achieve durable practice change without reinforcement and broader health system support.