Background: Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in\r\nresource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering\r\ncomprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility\r\ncharacteristics associated with providers� knowledge and clinical skills.\r\nMethods: Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn\r\nresuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and\r\ninfrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses\r\nwere performed using STATA 11.2 and SAS 9.1.3.\r\nResults: Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag,\r\nand mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely\r\nthan doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No\r\nsignificant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in\r\nperforming newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge\r\nquestions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in\r\ntheir ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and\r\nclinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience\r\noffering EmONC services.\r\nConclusions: Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan,\r\nbut providers� knowledge and skills need strengthening in some areas. Midwives proved to be as capable as\r\ndoctors of performing newborn resuscitation, which validates the major investment made in midwifery education.\r\nCompetency-based pre-service and in-service training, complemented by supportive supervision, is an effective way\r\nto build providers� capacity to perform newborn resuscitation. This kind of training could also help skilled birth\r\nattendants based in the community, at private clinics, or at primary care facilities save the lives of newborns.
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