Introduction

From June 27 to 29, 2024, the Ethiopian Pediatric Society (EPS) organized a comprehensive three-day Training of Trainers (TOT) session focused on Blended Catchment Based Clinical Mentorship to implement the new WHO guidelines for low birth weight (LBW) and premature newborn care. This training was attended by senior pediatricians/neonatologists, NICU heads (nurses), and labor and delivery heads (midwives) from six selected hospitals of five regions (Oromia, Amhara, Tigray, Sidama, and Afar). The goal was to equip them with mentorship skills and enhance their skills and knowledge in providing specialized care for LBW, premature, small, and sick newborns (SSNC). The training included a mix of lectures, discussions, demonstrations, group work, site visits, and reflective practice, ensuring an immersive and practical learning experience.

Objectives

The primary objectives of the training were to:

1. Equip healthcare professionals with the latest WHO guidelines for LBW and premature newborn care.
2. Develop effective clinical mentorship skills among participants.
3. Utilize the GROW Model (Goal, Reflect on reality, Options and Obstacles, and Will for Way forward) for addressing challenges in Small and Sick Newborn Care (SSNC).
4. Promote the implementation of quality improvement initiatives in neonatal care.
5. Foster a synergistically integrated multidisciplinary approaches to improve care for SSNC.

Participants and Trainers

Participants

The trainees included pediatricians, NICU heads (nurses), and labor and delivery heads (midwives) from the following hospitals along with their respective regions:

• Adama Referral Hospital (Oromia-West)
• Jimma Comprehensive Specialized Hospital (Ormia-East)
• Ayder Comprehensive Specialized Hospital (Tigray)
• Felegehiwot Comprehensive Specialized Hospital (Amhara)
• Hawassa Comprehensive Specialized Hospital (Sidama)
• Dubti Referral Hospital (Afar)

Each participant is expected to provide continuous mentorship (in a group) to their respective networked catchment hospitals on a monthly basis in person. In between the in-person mentorships, virtual mentorship will be given from the EPS hub (center) through the iECHO projects, "All Teach, All Learn" platform.

Trainers

The training was facilitated by senior neonatologists and pediatricians:

• Dr. Gesit Metaferia (Saint Paul Hospital)
• Dr. Mahlet Abayneh (Saint Paul Hospital)
• Dr. Asrat Demtse (Tikur Anbessa Specialized Hospital)
• Professor Bogale Worku (Senior Pediatrician and Executive Director from EPS)

Methodology

Training Approaches

The training employed various instructional methods to ensure a comprehensive learning experience:

• Lectures: Provided foundational knowledge and updates on the new WHO guidelines, mentorship principles, and GROW model.
• Discussions: Allowed participants to share insights and experiences on each point of care.
• Demonstrations: Showcased practical techniques in newborn point of cares.
• Group Work and Presentations: Encouraged collaborative learning and problem-solving.
• Site Visits: Included practical attachments to Saint Paul Millennium Medical College Hospital’s Labor and Delivery, NICU, and KMC units.
• Reflections: Facilitated discussions on observations from site visits, highlighting strengths, areas for improvement, and key takeaways.

Points of Care Addressed

The training focused on eight critical points of care for small and sick newborns (SSNC):

1. Immediate Newborn Care
2. Respiratory Support: CPAP & Safe Oxygen Use for Small Babies
3. Kangaroo Mother Care
4. Monitoring of Sick Newborn (Including Thermal Care)
5. Breast and Breastmilk Feeding Support
6. Prevention of Infections
7. Detection and Management of Infections
8. Developmentally Supportive and Nurturing Care

In addition, the common neonatal problems (such as jaundice, NEC, apnea, anemia, encephalopathy, seizures, and birth defects) and quality improvement were also addressed on the TOT training. In each point of care, participants were guided to develop GROW Models to identify and address key problems that they have appreciated in their setup through mentorship.

Training Schedule and Activities

Day 1: June 27, 2024

The training commenced with opening remarks and introductions by Prof. Bogale Worku, who also outlined the meeting objectives and presentation on Principles of Mentorship. Dr. Gesit Metaferia presented on the care of small and sick newborns (SSNC) and the 10 core components of SSNC.

Participants were then introduced to mentoring skills and the GROW model by Dr. Gesit Metaferia. Throughout the day, participants engaged in point of care skill stations focusing on immediate care at birth and respiratory support (CPAP and safe oxygen use) led by Dr. Asrat Demtse and Dr. Gesit Metaferia, respectively. They also received orientation on the iECHO platform by Alina Rachel Santram from India, through Zoom meeting.

In the afternoon, participants attended additional skill stations on Kangaroo Mother Care (KMC) and thermal care & monitoring of sick newborns, facilitated by Dr. Mahlet Abayneh and Dr. Gesit Metaferia. The day concluded with a hospital visit at Saint Paul hospital for observation led by Dr. Gesit Metaferia and Dr. Mahlet Abayneh.

Day 2: June 28, 2024

Day two began with a recap session by Dr. Gesit Metaferia. Participants then rotated through skill stations focusing on breastfeeding support and the prevention of infections & IV fluid management, led by Dr. Gesit Metaferia and Dr. Asrat Demtse.

Later in the morning, Dr. Gesit Metaferia conducted a session on the detection and management of common neonatal conditions (such as jaundice, NEC, apnea, anemia, encephalopathy, seizures, and birth defects). In the afternoon, additional skill stations covered the detection and management of infections and developmentally supportive and nurturing care, facilitated by Dr. Asrat Demtse and Dr. Gesit Metaferia. The day concluded with a second day hospital visit (at Saint Paul Hospital) for observation, led by Dr. Gesit Metaferia and Dr. Asrat Demtse.

Day 3: June 29, 2024

The final day began with a recap session by Dr. Mahlet Abayneh. Participants were introduced to the SSNC checklist and assessment strategy through a discussion facilitated by Dr. Mahlet Abayneh.

The GROW model was demonstrated and discussed in groups on two selected point of care covered during the previous days. Following this, participants performed demonstrations through drama on Kangaroo Mother Care and prevention of infections, reflecting real-life situations they might face. Each group then received feedback on their demonstrations.

Later on, Prof. Bogale Worku delivered a lecture on Quality Improvement, followed by practice sessions on mentoring skills, communication, and feedback, led by Dr. Mahlet Abayneh and Dr. Asrat Demtse. The training concluded with a closing ceremony hosted by Prof. Bogale Worku.

Participant Feedback

The training received positive feedback from participants, who appreciated the blend of theoretical knowledge and practical experience. They expressed confidence in applying the new WHO guidelines and mentoring their colleagues to improve newborn care in their respective hospitals. Besides, they appreciated incorporation of site vist program in the TOT training and noted several strengths in the hospital setup, including: Well-equipped NICU with advanced respiratory support systems, integrated units of various labor and delivery and NICU/KMC units with energetic skillful staffs at Saint Paul hospital. They reflected that they took various lessons from the hospital that they will be applying both at their own hospitals and mentee hospitals with the available resources.

Conclusion

The three-day TOT training organized by the Ethiopian Pediatric Society was a significant step towards enhancing the care of LBW and premature newborns in Ethiopia. By equipping senior neonatologists, pediatricians, NICU heads, and labor and delivery heads with the latest guidelines and mentorship skills, the training has laid a strong foundation for improving neonatal health outcomes. The integration of quality improvement initiatives and the development of GROW Models will further support the continuous enhancement of newborn care practices across the country.

Next Steps

To sustain and build upon the achievements of this training, the following key actions will be taken:

1. Mentorship Programs: Establish structured mentorship programs within hospitals and to the mentee hospitals to support the continuous professional development of healthcare providers.
2. Quality Improvement Initiatives: Encourage hospitals to implement quality improvement projects focused on the eight points of care addressed in the training.
3. Data Collection and Analysis: Strengthen data collection and analysis systems (at baseline, midline and endline) to monitor the impact of interventions and inform future improvements.

By implementing these actions, the Ethiopian Pediatric Society and its partners can ensure the sustained improvement of newborn care across the country.

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