Retention of knowledge and skills among midwives one year after completing helping babies breathe pre-service training in Ethiopia: a non-randomized quasi-experimental study

Abstract

BACKGROUND: Neonatal mortality remains a significant public health challenge in Ethiopia, often attributed to asphyxia at birth. Helping Babies Breathe (HBB), an evidence-based neonatal resuscitation program aims to address this issue. However, the sustainability of knowledge and skills acquired during pre-service training is less understood. OBJECTIVE: This study assessed the retention of knowledge and skills among midwives one year after completing the HBB pre-service training in Ethiopia. METHODS: A non-randomized quasi-experimental study was conducted involving a cohort of midwifery graduates who completed HBB training during their final year. Knowledge was assessed using a multiple-choice questionnaire, while skills were evaluated using Objective Structured Clinical Examinations (OSCEs). Data were collected immediately post-training, six months later, and one year later. Paired t-tests and Wilcoxon signed-rank tests were used to analyze changes over time. RESULTS: Of the 60 midwives initially trained, 50 (83.3%) participated in the follow-up assessment. The median knowledge score decreased significantly from 98% immediately post-training to 74% one year later (p < 0.01). Similarly, OSCE performance declined, with 36% of participants demonstrating proficiency compared to 62% at baseline (p < 0.05). A paired t-test was performed to evaluate whether students' psychomotor skills significantly declined 12 months after initial training. The results of the analysis showed a highly significant decline in psychomotor skills during this time, with a mean difference of -2.29 (SE = 0.29; p < 0.001). This negative mean difference, with pre-test scores averaging 27.59 (SD = 2.78) and post-test scores after 12 months averaging 25.31 (SD = 2.11), indicates a noticeable drop in skill levels following training. CONCLUSION: While midwives retained moderate knowledge and skills one year after completing HBB training, significant attrition highlights the need for periodic refresher training and improved access to resuscitation tools. Strengthening these aspects may enhance the long-term impact of HBB in reducing neonatal mortality.