PROJECT SUMMARY

PROJECT DESCRIPTION

Perinatal asphyxia remains a critical global health challenge, causing approximately 4 million neonatal deaths annually, with disproportionately higher incidence in low-income countries like Ethiopia. In Southern Ethiopia, 13.5% of neonatal mortality is attributed to asphyxia, often linked to inadequate healthcare provider skills in managing labor complications. Vacuum extraction (VE) and neonatal resuscitation are evidence-based interventions that can reduce asphyxia and unnecessary cesarean sections, yet they are significantly underutilized in Sub-Saharan Africa due to lack of training, equipment, and skilled operators. This innovative project proposes a four-arm randomized controlled trial (RCT) factorial design in primary hospitals in South Ethiopia (January-December 2025) to evaluate a simulation-based training combined with clinical mentorship. Arm 1 receives simulation training on vacuum-assisted delivery (VAD) and mentorship; Arm 2 focuses on neonatal resuscitation (NR) with mentorship; Arm 3 combines both VAD and NR simulation training and mentorship; and a Control Group receives standard training. All groups are in resource-limited, high neonatal mortality settings. The study will include all 4,770 births in selected facilities. Twelve non-physician clinicians will first receive 'Training of Trainers' (TOT) for VAD and NR, mentored by senior specialists. They will then train all midwives in their respective hospitals through weekly six-month simulation-based sessions, progressing from basic to advanced skills. The control group will continue with traditional clinical education. Data will be collected via pre/post-intervention surveys, competency assessments, and qualitative interviews (10-15 key informants). Analysis will use intention-to-treat principles, multivariate logistic regression, and thematic analysis. This project aims to enhance midwife competencies, improve neonatal survival, and provide a scalable model for reducing perinatal asphyxia in vulnerable populations, aligning with global health goals.