Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study

OBJECTIVE: To determine retention of knowledge and skills after standardised “skills and drills” training in Emergency Obstetric Care. DESIGN: Longitudinal cohort study. SETTING: Ghana, Malawi, Nigeria, Kenya, Tanzania and Sierra Leone. POPULATION: 609 maternity care providers, of whom 455 were nurse/midwives (NMWs) METHODS: Knowledge and skills assessed before and after training, and, at 3, 6, 9 and 12 months. Analysis of variance to explore differences in scores by country and level of healthcare facility for each cadre. Mixed effects regression analysis to account for potential explanatory factors including; facility type, years of experience providing maternity care, months since training and number of repeat assessments. MAIN OUTCOME MEASURES: Change in knowledge and skills. RESULTS: Before training the overall mean (SD) score for skills was 48.8% (11.6%) and 65.6% (10.7%). for knowledge. After training the mean (95% CI) relative improvement in knowledge was 30.8% (29.1% - 32.6%) and 59.8% (58.6%– 60.9%) for skills. Mean scores for knowledge and skills at each subsequent assessment remained between those immediately post-training and those at 3 months. NMWs who attended all four assessments demonstrated statistically better retention of skills (14.9%, 95% CI 7.8%, 22.0% p<0.001) but not knowledge (8.6%, 95% CI -0.3%, 17.4%. p = 0.06) compared to those who attended one or two assessments only. Health care facility level or experience were not determinants of retention. CONCLUSIONS: After training, healthcare providers retain knowledge and skills for up to 12 months. This effect can likely be enhanced by short repeat skills-training sessions, or, ‘fire drills’.