Comparison of two training strategies for essential newborn care in Brazil

Objective To compare the effectiveness of two training strategies for impro ving essential newborn care in the state of Pernambuco, Brazil. Methods Eight hospitals were selected, divided into two groups of four, and paired by geographical, structural, and functional characteristics. Doctor s and nurses working at hospitals in Group 1 were given a conventional 5-da y training course, Those in Group 2 were given the same manual used by Grou p 1 but the training course was organized as self-directed learning, with t he participants having 5 weeks to complete the course. Participants' knowle dge was tested at baseline, immediately after the course, and 3-6 months la ter, Participants' practices were observed before training and 3-6 months a fter training during 20 births and by interviewing 20 mothers before discha rge at each hospital. Findings Not all participants completed all of the tests. The scores on the tests of knowledge improved more among those in Group 2 than those in Grou p 1 when the answers were classified as right or wrong, but there was no di fference between groups when a scoring method was used that classified answ ers as correct, partially correct, incorrect, or missing. Practices related to thermal control after birth improved among those in Group 2 after train ing but practices related to thermal control on the ward worsened. The prom otion of breastfeeding improved in both groups. Conclusion There was no difference between the two training strategies, alt hough self-directed learning was cheaper than conventional training. Neithe r strategy brought about the expected improvements in the quality of care, other interventions in addition to training may be needed to improve care.