Knowledge and skills retention among health providers trained in advanced life support in obstetrics in Cameroon

Abstract

Introduction: Advanced Life Support in Obstetrics (ALSO) is an educational programme meant for the preservation and passage of knowledge and skills necessary to deal with urgent and emergent conditions that arise during the course of labour and delivery of care by using mannequins, mnemonics and evidence-based approaches. Objective: The aim of this study was to determine knowledge and skills retention 6-30 months following the ALSO training in Cameroon, determine factors that affect retention and relationship between knowledge and skills retention with confidence in managing obstetric emergencies. Method: This was a before and after study where data collected immediately after ALSO training (available in Cameroon Baptist Convention Health Services(CBCHS) computerized archive under control of the personnel manager) was compared with data collected 11 to 30 months after the training by administering questionnaire and the same practical exam that was given immediately after training. Result: There were 100 participants, 32(32%) met the criteria for knowledge/skill (KS) retention. The level of KS retention 41% during survey was significantly lower compared to 66% (p=0.0003) recorded immediately after training. Five potential predictors: being an instructor, number of vacuum deliveries performed, location of practice, time since training, and participant’s profession were significantly associated with KS retention. Participants who worked in urban area were 5.9 (95%CL 1.34-25.71) times more likely to retain their KS than those who worked in rural area. Instructors were 8.3 times more likely to retain their KS than non-instructors. Generally, the participants who retained KS were more confident in managing obstetric emergencies. Conclusion: Only 32% of ALSO providers trained in Cameroon under the CBCHS were able to retain their KS 11 to 30 months after training. Factors positively affecting KS retention were: being an instructor, number of vacuum deliveries performed, working in urban area, time since training, and participants’ profession. Participants who retained their knowledge and skill tend to feel more comfortable in managing obstetric emergencies than those who did not retain their KS, except for maternal resuscitation. Recommendations: This study recommends that refresher courses should be carried out at least on yearly basis. ALSO providers should be rotated between urban and rural areas. Similar studies be carried out on real life situation of human patients to assess the affective domain of care.