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Effect of 'Helping Babies Breathe' Training on Ethiopian Undergraduate Midwifery Students' Knowledge and Skills in Neonatal Resuscitation at Public Universities: A Non-Randomized Quasi-Experimental Study

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Title: Effect of 'Helping Babies Breathe' Training on Ethiopian Undergraduate Midwifery Students' Knowledge and Skills in Neonatal Resuscitation at Public Universities: A Non-Randomized Quasi-Experimental Study
Language: English
Authors: Endalew Gemechu Sendo (ORCID 0000-0001-7768-0196), Girum Sebsibe Teshome, Wegnesh Kelbessa Jirata, Lemi Abebe Gebrewold, Rahel Endalew Gemechu
Source: SAGE Open. 2025 15(1).
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 10
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Foreign Countries, Undergraduate Students, Obstetrics, Birth, Neonates, Infant Care, Infant Mortality, Program Effectiveness, Program Implementation, Academic Achievement, Skill Development, Public Colleges
Geographic Terms: Ethiopia
DOI: 10.1177/21582440251316932
ISSN: 2158-2440
Abstract: Helping Babies Breathe (HBB) is a global initiative launched by the American Academy of Pediatrics (AAP) in 2010, aimed at reducing neonatal mortality by addressing birth asphyxia, a leading cause of newborn deaths worldwide. The HBB training program trains providers in effectively resuscitating infants in developing countries, including Ethiopia. This study aims to examine the effects of HBB training on the knowledge and performance of undergraduate fourth-year midwifery students in neonatal resuscitation in public Ethiopian higher education institutions. The current study used a quasi-experimental study design. The study made use of the same research participants before and after the HBB Training. Pre- and post-knowledge tests, Objective structured clinical examinations (OSCEs), and a checklist for bag and mask ventilation skills checklist were used to assess the effectiveness of the HBB training. The data generated from pre and post-test results were imported into EPi Data version 4.0.2.49 and exported into SPSS version 25 for analysis. The data was correlated in nature due to its inherent source. After testing the assumptions, a paired t-test was used to examine the effect of HBB simulation training on the knowledge level of fourth-year midwifery students. The difference in the pre and post-training knowledge level of the students was declared as statistically significant at a p-value of .05. A total of 60 research participants from two public health science colleges that offer undergraduate midwifery training enrolled in this study; 54 of them received 2 days of HBB training in two phases and completed the pre- and immediate post-test course assessments. Six participants left the study for personal reasons. Of the participants in the study, 43 were female and 11 were male. The study participants were between the ages of 21 and 25, with a mean age of 22.47 years. The results demonstrated that, although before the intervention, over 25% of research participants (18; 29.63%) lacked adequate knowledge about managing birth asphyxia, all of them acquired adequate knowledge[[greater than or equal to]80%] after the intervention. T-tests after the HBB intervention also revealed a substantial improvement in knowledge [[d-bar] + SE: 2.09 + 2.13, p < 0.001]. Similarly, following the HBB intervention, 43 research participants [or more than 3/4 of the sample] demonstrated appropriate skills [[greater than or equal to]80%] for neonatal resuscitation, according to the findings of the OSCE-A and OSCE-B psychomotor skill assessments. The HBB program is a lifesaving training program designed for low-income countries. The study's findings showed that the participants' knowledge and skills of infant resuscitation were significantly improved by the HBB training course. The HBB training program has the utmost impact if pre-service refresher courses on neonatal resuscitation are offered to the midwife trainees before they join the national midwifery task forces.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1466997
Database: ERIC
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  Value: &lt;anid&gt;AN0184162301;[kbz6]01jan.25;2025Apr03.02:11;v2.2.500&lt;/anid&gt; &lt;title id=&quot;AN0184162301-1&quot;&gt;Effect of &quot;Helping Babies Breathe&quot; Training on Ethiopian Undergraduate Midwifery Students&#39; Knowledge and Skills in Neonatal Resuscitation at Public Universities: A Non-Randomized Quasi-Experimental Study&#160;&lt;/title&gt; &lt;p&gt;Helping Babies Breathe (HBB) is a global initiative launched by the American Academy of Pediatrics (AAP) in 2010, aimed at reducing neonatal mortality by addressing birth asphyxia, a leading cause of newborn deaths worldwide. The HBB training program trains providers in effectively resuscitating infants in developing countries, including Ethiopia. This study aims to examine the effects of HBB training on the knowledge and performance of undergraduate fourth-year midwifery students in neonatal resuscitation in public Ethiopian higher education institutions. The current study used a quasi-experimental study design. The study made use of the same research participants before and after the HBB Training. Pre- and post-knowledge tests, Objective structured clinical examinations (OSCEs), and a checklist for bag and mask ventilation skills checklist were used to assess the effectiveness of the HBB training. The data generated from pre and post-test results were imported into EPi Data version 4.0.2.49 and exported into SPSS version 25 for analysis. The data was correlated in nature due to its inherent source. After testing the assumptions, a paired t -test was used to examine the effect of HBB simulation training on the knowledge level of fourth-year midwifery students. The difference in the pre and post-training knowledge level of the students was declared as statistically significant at a p -value of.05. A total of 60 research participants from two public health science colleges that offer undergraduate midwifery training enrolled in this study; 54 of them received 2 days of HBB training in two phases and completed the pre- and immediate post-test course assessments. Six participants left the study for personal reasons. Of the participants in the study, 43 were female and 11 were male. The study participants were between the ages of 21 and 25, with a mean age of 22.47 years. The results demonstrated that, although before the intervention, over 25% of research participants (18; 29.63%) lacked adequate knowledge about managing birth asphyxia, all of them acquired adequate knowledge[≥80%] after the intervention. T -tests after the HBB intervention also revealed a substantial improvement in knowledge [ d &#175; + SE: 2.09 + 2.13, p &amp;lt;.001]. Similarly, following the HBB intervention, 43 research participants [or more than 3/4 of the sample] demonstrated appropriate skills [≥80%] for neonatal resuscitation, according to the findings of the OSCE-A and OSCE-B psychomotor skill assessments. The HBB program is a lifesaving training program designed for low-income countries. The study&#39;s findings showed that the participants&#39; knowledge and skills of infant resuscitation were significantly improved by the HBB training course. The HBB training program has the utmost impact if pre-service refresher courses on neonatal resuscitation are offered to the midwife trainees before they join the national midwifery task forces.&lt;/p&gt; &lt;p&gt;Plain language summary: &#39;&#39;Helping Babies Breathe&#39;&#39; training for undergraduate midwifery in Ethiopia Plain Language Summary Research evaluating the skills of Ethiopian undergraduate midwifery students in neonatal resuscitation is scarce. The aim of this study is to examine the effects of HBB training on the knowledge and performance of undergraduate fourth-year midwifery students in neonatal resuscitation in public Ethiopian higher education institutions. The current study used a quasi-experimental study design. After testing of the assumptions, a paired t -test was used to examine the effect of HBB simulation training on the knowledge level of fourth-year midwifery students. The difference in the pre and post-training knowledge level of the students was declared as statistically significant at a p -value of 0.05. The results demonstrated that, although before the intervention, over 25% of research participants (18; 29.63%) lacked adequate knowledge about managing birth asphyxia, all of them acquired adequate knowledge[≥80%] after the intervention. T -tests after the HBB intervention also revealed a substantial improvement in knowledge [ d &#175; + SE : 2.09 + 2.13, p &amp;lt;.001]. Similarly, following the HBB intervention, 43 research participants [or more than 3/4 of the sample] demonstrated appropriate skills [≥80%] for neonatal resuscitation, according to the findings of the OSCE-A and OSCE-B psychomotor skill assessments. The HBB program is a lifesaving training program designed for low-income countries. The study&#39;s findings showed that the participants&#39; knowledge and skills of infant resuscitation were significantly improved by the HBB training course.&lt;/p&gt; &lt;p&gt;Keywords: helping babies breathe; birth asphyxia; neonatal resuscitation; golden minute; midwifery students; public higher education; Ethiopia&lt;/p&gt; &lt;hd id=&quot;AN0184162301-2&quot;&gt;Background&lt;/hd&gt; &lt;p&gt;Globally, 2.3 million babies died in the first month of life in 2022, or over 6,300 neonatal deaths every day ([&lt;reflink idref=&quot;bib32&quot; id=&quot;ref1&quot;&gt;32&lt;/reflink&gt;]). The majority of these deaths occur in low- and middle-income countries (LMICs) ([&lt;reflink idref=&quot;bib4&quot; id=&quot;ref2&quot;&gt;4&lt;/reflink&gt;]). One of the main causes of death in neonates is asphyxia, which occurs when they are unable to breathe on their own and need assistance to begin or continue breathing ([&lt;reflink idref=&quot;bib17&quot; id=&quot;ref3&quot;&gt;17&lt;/reflink&gt;]). The majority of all neonatal deaths (75%) occur during the first week of life, and about 1 million newborns die within the first 24 hours ([&lt;reflink idref=&quot;bib21&quot; id=&quot;ref4&quot;&gt;21&lt;/reflink&gt;]). Newborns who suffer from birth asphyxia are typically flaccid, white/bluish, non-breathing, and have a slow or absent heart rate. (&lt;reflink idref=&quot;bib5&quot; id=&quot;ref5&quot;&gt;5&lt;/reflink&gt;) Worldwide, birth asphyxia is responsible for about 25% of newborn deaths. According to this study, birth asphyxia is defined as the incapacity to initiate and sustain breathing at birth. Early and effective resuscitation can save a sizable portion of these deaths ([&lt;reflink idref=&quot;bib35&quot; id=&quot;ref6&quot;&gt;35&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Sub-Saharan Africa (SSA) has a newborn mortality rate that is 10 times higher than that of high-income regions, with 28 deaths per 1,000 live births ([&lt;reflink idref=&quot;bib17&quot; id=&quot;ref7&quot;&gt;17&lt;/reflink&gt;]) The current infant mortality rate for Ethiopia in 2024 is 28 deaths per 1,000 live births ([&lt;reflink idref=&quot;bib21&quot; id=&quot;ref8&quot;&gt;21&lt;/reflink&gt;]). There hasn&#39;t been a statistically significant drop in newborn mortality as a result of the Health Sector Transformation Plan I (HSTP-I) package of interventions in Ethiopia (Is Neonatal Mortality Rate in Ethiopia Going from Bad to Worse?, n.d.).&lt;/p&gt; &lt;p&gt;While there are several potential obstacles, such as the nation&#39;s pervasive political unrest, the current state of success is insufficient ([&lt;reflink idref=&quot;bib11&quot; id=&quot;ref9&quot;&gt;11&lt;/reflink&gt;]). According to the Sustainable Development Goal [SDG]−three targets, all nations must reduce the infant death toll that could have been prevented by 2030, meaning that the global neonatal mortality rate could drop to as low as 12 per 1,000 live births. One of the participating nations, Ethiopia, is expected to reach the specified goal by 2030 ([&lt;reflink idref=&quot;bib33&quot; id=&quot;ref10&quot;&gt;33&lt;/reflink&gt;]). Ethiopia&#39;s neonatal care focuses on improving maternal and newborn health through the Health Sector Transformation Plan and the National Strategy for Newborn and Child Survival. Key practices include Essential Newborn Care (ENC) which includes immediate drying and wrapping of the newborn to prevent hypothermia, early initiation of breastfeeding, and delayed bathing to prevent infections. These practices are increasingly common in Ethiopian health facilities, but there are still gaps in rural areas where home births are prevalent ([&lt;reflink idref=&quot;bib3&quot; id=&quot;ref11&quot;&gt;3&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref12&quot;&gt;26&lt;/reflink&gt;]). Ethiopia has emphasized the importance of antenatal care (ANC) visits and postnatal follow-ups to identify and manage risks early. However, access to quality care remains uneven, with rural areas experiencing higher neonatal mortality rates due to limited health infrastructure ([&lt;reflink idref=&quot;bib9&quot; id=&quot;ref13&quot;&gt;9&lt;/reflink&gt;]). Health extension workers (HEWs) play a crucial role in providing neonatal care, especially in rural regions. They offer services such as home visits, health education, and referrals to health centers ([&lt;reflink idref=&quot;bib26&quot; id=&quot;ref14&quot;&gt;26&lt;/reflink&gt;]). In the broader East African context, Ethiopia&#39;s neonatal care practices are comparable to those in countries like Uganda, Tanzania, and Kenya, though with some differences. Ethiopia, like other East African countries, has made strides in ensuring early drying and wrapping of newborns. However, inconsistencies remain, especially in home deliveries where traditional practices might delay these critical actions ([&lt;reflink idref=&quot;bib26&quot; id=&quot;ref15&quot;&gt;26&lt;/reflink&gt;]). While Ethiopia has made notable progress in neonatal care, challenges related to healthcare accessibility, cultural practices, and resource constraints persist. These challenges are not unique to Ethiopia but are seen across East Africa. Continuous efforts to strengthen health systems, train healthcare providers, and improve community-based care are essential for further reducing neonatal mortality in Ethiopia and the region.&lt;/p&gt; &lt;p&gt;The American Academy of Pediatrics (AAP), in partnership with the World Health Organization (WHO), launched and developed the life-saving training program Helping Babies Breathe (HBB) in 2010 ([&lt;reflink idref=&quot;bib20&quot; id=&quot;ref16&quot;&gt;20&lt;/reflink&gt;]). Neonatal resuscitation is a critical task for healthcare professionals (HCPs) that must be completed in the first minute after delivery, sometimes known as The Golden Minute. These techniques are taught in the HBB program ([&lt;reflink idref=&quot;bib34&quot; id=&quot;ref17&quot;&gt;34&lt;/reflink&gt;]). It is essential to the infant&#39;s survival and potential growth during this critical stage of extrauterine life when they transition from a fetus to a newborn breathing ([&lt;reflink idref=&quot;bib17&quot; id=&quot;ref18&quot;&gt;17&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib20&quot; id=&quot;ref19&quot;&gt;20&lt;/reflink&gt;]). In 90% of cases, spontaneous breathing can be quickly induced by basic methods such as drying, stimulating, and possibly suctioning the newborn (if necessary). These are the Golden Minute protocol&#39;s initial phases ([&lt;reflink idref=&quot;bib8&quot; id=&quot;ref20&quot;&gt;8&lt;/reflink&gt;]). Most notably, this life-saving kit teaches these skills without teaching complicated methods like medicine administration and chest compression ([&lt;reflink idref=&quot;bib30&quot; id=&quot;ref21&quot;&gt;30&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Midwives are expected to have the requisite knowledge and skills of newborn resuscitation while attending a delivery to help prevent infant mortality and morbidity. Studies from other African countries, including Ethiopia ([&lt;reflink idref=&quot;bib29&quot; id=&quot;ref22&quot;&gt;29&lt;/reflink&gt;]) and Kenya ([&lt;reflink idref=&quot;bib23&quot; id=&quot;ref23&quot;&gt;23&lt;/reflink&gt;]), however, reported that midwives and other medical professionals had insufficient training in infant resuscitation. Over 70% of medical professionals, including midwives, said that their pre-service education program had left them with insufficient knowledge of neonatal resuscitation, according to the same Kenyan study. WHO Guidelines on Basic Neonatal Resuscitation recommend that healthcare workers should update their knowledge and skills regularly, preferably every 2 years ([&lt;reflink idref=&quot;bib35&quot; id=&quot;ref24&quot;&gt;35&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Effective pre-service education can support high-quality midwifery care to minimize maternal and newborn mortality and morbidity in poor countries ([&lt;reflink idref=&quot;bib10&quot; id=&quot;ref25&quot;&gt;10&lt;/reflink&gt;]), including Ethiopia. According to a prior study conducted in Ethiopia, the graduating midwifery students received inadequate pre-service education and they lacked the necessary competencies ([&lt;reflink idref=&quot;bib36&quot; id=&quot;ref26&quot;&gt;36&lt;/reflink&gt;]). Pre-service and in-service competence training, supplemented by supportive supervision, is an effective way to build providers&#39; capacity to perform newborn resuscitation ([&lt;reflink idref=&quot;bib19&quot; id=&quot;ref27&quot;&gt;19&lt;/reflink&gt;]). However, the &quot;HBB&quot; pre-service training course for midwife trainees that offer HBB care in healthcare facilities is not well documented. Building the competency of final-year midwifery students through HBB training could undoubtedly help increase their knowledge and skills, in addition to lowering the incidence of newborn morbidity and death toll across the country. This study aims to examine the effects of &quot;HBB&quot; training on the newborn resuscitation knowledge and skills of Ethiopian undergraduate fourth-year midwifery students attending public universities in Ethiopia.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-3&quot;&gt;Research Questions&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;ulist&gt; &lt;item&gt; • What is the level of knowledge regarding basic neonatal resuscitation at birth among fourth-year undergraduate midwifery students who have attended the program with the conventional midwifery curriculum?&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; • Does HBB simulation-based training bring a change in the neonatal resuscitation knowledge of fourth-year midwifery students who have attended the program with the conventional midwifery curriculum?&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; • Can fourth-year midwifery students who have completed simulation-based HBB training achieve the anticipated level of competence in newborn resuscitation skills?&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; Hypothesis 1 &lt;/bold&gt; : HBB simulation-based training improves the newborn resuscitation knowledge level of fourth-year midwifery students.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; Hypothesis 2: &lt;/bold&gt; The fourth-year midwifery students can attain the expected level of expertise in newborn resuscitation skills after completing HBB simulation-based training.&lt;/item&gt; &lt;/ulist&gt; &lt;hd id=&quot;AN0184162301-4&quot;&gt;Specific Objectives&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;ulist&gt; &lt;item&gt; • To determine the knowledge level of fourth-year undergraduate midwifery students who attended the program with the conventional midwifery curriculum regarding basic neonatal resuscitation at birth.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; • To evaluate the effect of HBB simulation-based training on the knowledge level of undergraduate fourth-year midwifery students regarding basic resuscitation of neonates at birth.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; • To examine the skill of undergraduate fourth-year midwifery students in performing basic newborn resuscitation at birth after HBB simulation-based training.&lt;/item&gt; &lt;/ulist&gt; &lt;hd id=&quot;AN0184162301-5&quot;&gt;Methods&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;hd id=&quot;AN0184162301-6&quot;&gt;Study Setting&lt;/hd&gt; &lt;p&gt;The study was conducted in the public Health Science College at Addis Ababa University [AAU] and Menelik II Medical &amp;amp; Health Science College in Addis Ababa, Ethiopia. These colleges were chosen to serve as the intervention sites due to their proximity and high student population in the Country. The College of Health Sciences (CHS) at Addis Ababa University (AAU) was established in 2009. The CHS is comprised of four schools and Tikur Anbessa Specialized Teaching Hospital [TASH]. These schools are the School of Medicine, the School of Pharmacy, the School of Public Health, and the School of Nursing and Midwifery. The School of Nursing and Midwifery of the CHS has two academic departments: the Department of Nursing and Midwifery. Thirty-two undergraduate fourth-year midwifery students were registered for the 2023 academic year. Menelik II Health Science College was established in 1949. This college currently offers a variety of regular undergraduate degrees, including nursing and midwifery programs. Thirty-four undergraduate fourth-year midwifery students were enrolled for the 2023 academic year.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-7&quot;&gt;Participant Recruitment&lt;/hd&gt; &lt;p&gt;The study population consisted of fourth-year midwifery students in their second-semester classes at the chosen Health Science Colleges. The purposive sampling strategy was used to recruit the study participants based on their proximity and high student population in the Country. All fourth-year midwife students in their second year of study who completed the basic newborn resuscitation course in the undergraduate midwifery conventional curriculum, who had never received HBB training before, and who granted consent to participate in the 2 day HBB Training program at the intervention sites were included in the study. The study comprised all 60 midwifery students who attended the program from the health science colleges that were purposively selected. To determine whether the data obtained from the participants was sufficient to detect the specified effect with the desired power, a power analysis was conducted using G*Power software Kang, H. ([&lt;reflink idref=&quot;bib16&quot; id=&quot;ref28&quot;&gt;16&lt;/reflink&gt;]). The designated colleges were then addressed in official letters requesting permission to conduct the study. The study participants were approached through the students&#39; representatives to obtain their consent to participate in the study. Sixty participants were then registered for the HBB Training.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-8&quot;&gt;The Research Design and Period&lt;/hd&gt; &lt;p&gt;Research design is the architecture of the study whereby its structure, namely the details of the study population, time frame, methods, and procedures are explicitly stated in the research protocol. The study design guides the methods and decisions that researchers must make during their studies and sets the logic by which they make interpretations at the end of their studies ([&lt;reflink idref=&quot;bib25&quot; id=&quot;ref29&quot;&gt;25&lt;/reflink&gt;]). The current study used a quasi-experimental study design. A quasi-experimental study design does not employ randomization in its evaluation of interventions. A quasi-experimental study design, often known as a nonrandomized, pre-post-intervention study, is commonly utilized in the medical literature ([&lt;reflink idref=&quot;bib12&quot; id=&quot;ref30&quot;&gt;12&lt;/reflink&gt;]). The same research participants were used in the current study both before and after the HBB Training. The training intervention took place from May 20, 2023, until July 30, 2023.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-9&quot;&gt;HBB Intervention and Measurement&lt;/hd&gt; &lt;p&gt;Two days of simulation-based HBB training were delivered in two stages at the College of Health Sciences at AAU and Menelik II Medical &amp;amp; Health Science College, which served as the intervention sites. Out of the 60 participants who registered for the program, 54 completed the pre-test and immediate post-test course evaluations of the HBB training program. The baseline data was collected at the start of the project before the HBB intervention. This baseline assessment aimed to determine how much theoretical knowledge and practical skill in neonatal resuscitation the study participants acquired from the conventional undergraduate midwifery curriculum. The study used the same research participants who took the baseline pretest before the training intervention and the post-test after receiving HBB training. The primary outcome of the study was to evaluate the effect of HBB training intervention on the knowledge and skills of participants on basic newborn resuscitation. This was determined through tests that measured changes before and immediately after the 2 day training.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-10&quot;&gt;Assessment of Knowledge and Practical Skill&lt;/hd&gt; &lt;p&gt;Two time points for testing were used to obtain scores: before training, and 2 days after training. The HBB training materials used in the study were developed by the AAP and WHO and were (Second edition) ([&lt;reflink idref=&quot;bib15&quot; id=&quot;ref31&quot;&gt;15&lt;/reflink&gt;]). A multiple-choice (MCQ) questionnaire was used to determine the level of HBB knowledge among participants. In low-income nations like Kenya, Rwanda, and Uganda, the questionnaire was previously verified, standardized, and adjusted for use in assessing healthcare professionals&#39; HBB knowledge in comparable contexts, such as Ethiopia([&lt;reflink idref=&quot;bib15&quot; id=&quot;ref32&quot;&gt;15&lt;/reflink&gt;]). To gauge their knowledge, participants completed a 30 minute written test before and, 2 days after training. The test consisted of 18 MCQs based on the HBB flip chart (Appendix S1).&lt;/p&gt; &lt;p&gt;A 4 hour training session and a 12 hour simulation-based training on &quot;HBB-plus&quot; courses were given to participants at each intervention site. These sessions were followed by demonstrations and participant-led return demonstrations. An assessment of post-course practical skills was conducted using the NeoNatalie mannequin, an inflatable simulator designed to teach basic neonatal resuscitation, and the Objective Structured Clinical Examination B (OSCE B) 2 days after training (Appendix S2). The training session was divided into smaller groups to ensure a ratio of one trainer to five trainees (1:5) and to provide them feedback on their skills. As the participants practiced on a mannequin, a designated instructor gave them instructions and gave them feedback on their skills. The OSCE B includes 18 items reflecting the key components of the course. Each item was scored a one if carried out correctly. Any partially correct or incorrect action was scored as 0. A passing score required 14 items to be completed (78%) of a total of 18 tasks. The 14 items correctly performed must include the following main procedures: recognize baby is not breathing, ventilate at 40 breaths per minute, look for chest movement, and improve ventilation. The HBB training was led by the principal investigator (PI), a midwifery educator, and one tutor who is a Master HBB-certified midwife.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-11&quot;&gt;Data Analysis&lt;/hd&gt; &lt;p&gt;The data generated from pre and post-test results was imported into EPi Data version 4.0.2.49 and exported into SPSS version 25 for analysis. The data was correlated in nature due to its inherent source. After testing the assumptions, a paired &lt;emph&gt;t&lt;/emph&gt;-test was used to examine the effect of HBB simulation training on the knowledge level of fourth-year midwifery students ([&lt;reflink idref=&quot;bib31&quot; id=&quot;ref33&quot;&gt;31&lt;/reflink&gt;]). The difference in the pre and post-training knowledge level of the students was declared as statistically significant at a &lt;emph&gt;p&lt;/emph&gt;-value of.05. At the end of the training, all students are expected to acquire the skills required to perform basic newborn resuscitation at birth. A binomial test was applied to test whether all of the students had acquired the necessary skills. The results were presented in tables and narrated.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-12&quot;&gt;Results&lt;/hd&gt; &lt;p&gt;Sixty midwifery students participated in the HBB basic simulation training to evaluate its effect on the student&#39;s knowledge of neonatal resuscitation at birth and to determine the proportion of students who attained the requisite skills in neonatal resuscitation. The age and sex distribution of the study participants were described, and the results of the analysis on the effect of the training were presented in the subsequent table and described narratively.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-13&quot;&gt;Background Characteristics of Study Participants&lt;/hd&gt; &lt;p&gt;A total of 60 fourth-year midwifery students from two public health science colleges that offer undergraduate midwifery training enrolled in this study; 54 of them received 2 days of HBB training and completed the pre-and immediate post-test course assessments. Six research participants left the study for personal reasons. The study was conducted on an intention-to-treat basis, which includes all participants regardless of dropout. More than &lt;ephtml&gt; &amp;lt;math display=&quot;inline&quot; xmlns=&quot;http://www.w3.org/1998/Math/MathML&quot;&amp;gt;&amp;lt;mrow&amp;gt;&amp;lt;mn&amp;gt;3&amp;lt;/mn&amp;gt;&amp;lt;mo stretchy=&quot;false&quot;&amp;gt;/&amp;lt;/mo&amp;gt;&amp;lt;mn&amp;gt;4&amp;lt;/mn&amp;gt;&amp;lt;/mrow&amp;gt;&amp;lt;/math&amp;gt; &lt;/ephtml&gt; of the participants in the study were females. The mean age of the study participants was 22.47 years, ranging from 21 to 25 (Table 1).&lt;/p&gt; &lt;p&gt;Table 1. Age and Sex Distribution of Study Participants, July, 2023.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Variable&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Category&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Frequency (%)&amp;lt;italic&amp;gt;N&amp;lt;/italic&amp;gt; = 54&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td rowspan=&quot;2&quot;&amp;gt;Sex&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Male&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;11(20.37)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Female&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;43(79.63)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Age&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Mean(SD)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;22.47(1.03)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;hd id=&quot;AN0184162301-14&quot;&gt;Knowledge and Psychomotor Skills of Participants&lt;/hd&gt; &lt;p&gt;To evaluate the effectiveness of the HBB intervention, participants took a 30 minute written test with 18 multiple-choice questions before and after the HBB course to determine their level of knowledge of neonatal resuscitation. The findings showed that, before the intervention, more than a quarter of research participants (18; 29.63%) lacked adequate knowledge of how to manage neonatal resuscitation, after the intervention, all of them [100%] attained adequate knowledge of newborn resuscitation. Similarly, the OSCE-A and OSCE-B tools, which had 12 and 23 items, respectively, were used to assess the study participants&#39; psychomotor skills immediately [on the second day] after the intervention. Following the intervention, more than 3/4 of the sample, demonstrated appropriate skills [≥80%] for neonatal resuscitation, according to the findings of the OSCE-A and OSCE-B psychomotor skill assessments (Table 2).&lt;/p&gt; &lt;p&gt;Table 2. Knowledge and Psychomotor Skill Distribution of Study Participants, July, 2023.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Variable&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Category&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Frequency (%)&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td rowspan=&quot;2&quot;&amp;gt;Level of knowledge before intervention&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Adequate knowledge&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;38(70.37)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Inadequate knowledge&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;18(29.63)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td rowspan=&quot;2&quot;&amp;gt;Level of knowledge after intervention&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Adequate knowledge&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;54(100)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Inadequate knowledge&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0(0)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td rowspan=&quot;2&quot;&amp;gt;Psychomotor skill after intervention&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Adequate skills&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;43(79.63)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Inadequate skills&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;11(20.37)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;hd id=&quot;AN0184162301-15&quot;&gt;Evaluation of the Effectiveness of HBB Training in Enhancing Students&#39; Knowledge Levels and S...&lt;/hd&gt; &lt;p&gt;The descriptive results revealed that there was a difference in neonatal resuscitation knowledge between the pre-and post-intervention periods. Table 3 shows a comparison of the participants&#39; knowledge mean scores on the pretest and posttest on day two. Thus, the &lt;emph&gt;T&lt;/emph&gt;-test result indicated that there was a significant difference between the participants&#39; mean score for knowledge level before and after the training intervention ( &lt;ephtml&gt; &amp;lt;math display=&quot;inline&quot; xmlns=&quot;http://www.w3.org/1998/Math/MathML&quot;&amp;gt;&amp;lt;mrow&amp;gt;&amp;lt;mover&amp;gt;&amp;lt;mrow&amp;gt;&amp;lt;mi&amp;gt;d&amp;lt;/mi&amp;gt;&amp;lt;/mrow&amp;gt;&amp;lt;mo&amp;gt;&amp;amp;#175;&amp;lt;/mo&amp;gt;&amp;lt;/mover&amp;gt;&amp;lt;/mrow&amp;gt;&amp;lt;/math&amp;gt; &lt;/ephtml&gt; = 2.09, &lt;emph&gt;p&lt;/emph&gt; &amp;lt;.001). Therefore, HBB training can significantly improve participants&#39; knowledge of how to manage neonatal resuscitation (Table 3).&lt;/p&gt; &lt;p&gt;Table 3. Comparisons of participants&#39; HBB Knowledge Mean Scores Between the Pretest and Posttest, July 2023.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Variable&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Pre-interventionMean (SD)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Post-interventionMean (SD)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Mean of differences (SE)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;&amp;lt;italic&amp;gt;t&amp;lt;/italic&amp;gt;-value&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt;-value&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Knowledge level&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;15.22(2.30)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;17.31 (0.84)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.09(0.29)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7.23&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;.00&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;Although there was an improvement in the students&#39; knowledge levels after the training, the Binomial test results showed that the proportion of students who acquired the required skills was significantly less than one (0.999) or 100% (&lt;emph&gt;p&lt;/emph&gt; &amp;lt;.001) (See Table 4).&lt;/p&gt; &lt;p&gt;Table 4. Binomial Test for the Proportion of Students Who Acquired the Required Skills, July 2024.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;left&quot;&amp;gt;Acquired the required skills&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Frequency n (%)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Exact sig. (1-tailed)&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Yes&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;43(79.60)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.000&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;No&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;11(20.40)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;hd id=&quot;AN0184162301-16&quot;&gt;Discussion&lt;/hd&gt; &lt;p&gt;This study is the first to assess the knowledge and skills of final-year midwifery students at two Ethiopian midwifery training schools. The HBB package&#39;s standard tools, which have been validated and applied in various contexts where HBB knowledge and skill assessments have been carried out, were utilized to evaluate their knowledge and skills ([&lt;reflink idref=&quot;bib28&quot; id=&quot;ref34&quot;&gt;28&lt;/reflink&gt;]). The knowledge and skill level of fourth-year undergraduate midwifery students regarding basic newborn resuscitation at birth, particularly about their exposure to the HBB program, can vary significantly. This variability depends on factors such as the quality and extent of training they receive, the frequency of hands-on practice, and the overall integration of the HBB program into their curriculum ([&lt;reflink idref=&quot;bib13&quot; id=&quot;ref35&quot;&gt;13&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib17&quot; id=&quot;ref36&quot;&gt;17&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref37&quot;&gt;26&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib29&quot; id=&quot;ref38&quot;&gt;29&lt;/reflink&gt;]). The results of our study indicated that 2 days after receiving HBB training, participants&#39; knowledge and skills regarding basic newborn resuscitation at birth had enhanced. The findings of our study are in line with a study conducted in Rwanda ([&lt;reflink idref=&quot;bib17&quot; id=&quot;ref39&quot;&gt;17&lt;/reflink&gt;]), which evaluated the knowledge and skills that midwives and nurses at a sample of health centers in Kigali, Rwanda, were able to retain following 2 and 6 weeks of post-HBB training. Another Indian study ([&lt;reflink idref=&quot;bib6&quot; id=&quot;ref40&quot;&gt;6&lt;/reflink&gt;]) found that after receiving HBB training, the knowledge and competency levels of Indian physicians and nurses increased significantly. A study carried out in Delhi ([&lt;reflink idref=&quot;bib7&quot; id=&quot;ref41&quot;&gt;7&lt;/reflink&gt;]) found, in contrast to the results of the present study that nurses&#39; assessments of their knowledge and skills improved only slightly as a result of HBB training.&lt;/p&gt; &lt;p&gt;Newborn resuscitation is a critical skill for midwifery students, as timely and effective interventions can significantly reduce neonatal mortality. Studies show that without proper training, even students in their final year may lack confidence and competence in performing neonatal resuscitation effectively ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref42&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib27&quot; id=&quot;ref43&quot;&gt;27&lt;/reflink&gt;]). A study by Msemo et al. ([&lt;reflink idref=&quot;bib22&quot; id=&quot;ref44&quot;&gt;22&lt;/reflink&gt;]) demonstrated that effective training in newborn resuscitation, including the use of the HBB program, can substantially improve the skills and knowledge of healthcare providers. The HBB program, specifically designed for low-resource settings, emphasizes the &quot;Golden Minute&quot; after birth, where immediate assessment and intervention are crucial. The pre-test knowledge levels in our study were different, with an overall mean score of 15.22 (SD 2.3). This outcome is higher than the mean pre-test knowledge score of 7.22 for nurses in an Indian study ([&lt;reflink idref=&quot;bib15&quot; id=&quot;ref45&quot;&gt;15&lt;/reflink&gt;]). Likewise, a study conducted in Nepal to evaluate the effects of a 3 day course in neonatal resuscitation revealed a low pre-test knowledge score ([&lt;reflink idref=&quot;bib18&quot; id=&quot;ref46&quot;&gt;18&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;According to evaluation research carried out in Ethiopia, health workers&#39; knowledge of newborn resuscitation improved quickly following training, and the knowledge gap that existed before training was resolved ([&lt;reflink idref=&quot;bib14&quot; id=&quot;ref47&quot;&gt;14&lt;/reflink&gt;]). Our findings showed that while before the intervention, more than a quarter of research participants lacked sufficient knowledge of newborn resuscitation, after the intervention, all of them acquired sufficient knowledge. The &lt;emph&gt;T&lt;/emph&gt;-test results in our study also indicated a significant difference in the mean score for knowledge level before and after the training intervention ( &lt;ephtml&gt; &amp;lt;math display=&quot;inline&quot; xmlns=&quot;http://www.w3.org/1998/Math/MathML&quot;&amp;gt;&amp;lt;mrow&amp;gt;&amp;lt;mover&amp;gt;&amp;lt;mrow&amp;gt;&amp;lt;mi&amp;gt;d&amp;lt;/mi&amp;gt;&amp;lt;/mrow&amp;gt;&amp;lt;mo&amp;gt;&amp;amp;#175;&amp;lt;/mo&amp;gt;&amp;lt;/mover&amp;gt;&amp;lt;/mrow&amp;gt;&amp;lt;/math&amp;gt; &lt;/ephtml&gt; + &lt;emph&gt;SE&lt;/emph&gt;: 2.09 + 2.13, &lt;emph&gt;p&lt;/emph&gt; &amp;lt;.001). This implies that participants&#39; knowledge of managing newborn resuscitation can be greatly enhanced by HBB training. Our findings are consistent with a study from Nepal ([&lt;reflink idref=&quot;bib18&quot; id=&quot;ref48&quot;&gt;18&lt;/reflink&gt;]) that reported after receiving HBB training, the mean knowledge score increased significantly (&amp;lt;0.001) from 12.8 &#177; 1.6 at baseline to 16.4 &#177; 1.4.&lt;/p&gt; &lt;p&gt;Similarly, according to the results of the OSCE-A and OSCE-B psychomotor skill evaluations, more than 3/4 of the sample in the current study showed appropriate skills [≥80%] for newborn resuscitation after the HBB intervention. This finding is in line with a study done in Nepal ([&lt;reflink idref=&quot;bib18&quot; id=&quot;ref49&quot;&gt;18&lt;/reflink&gt;]) that revealed 93% of health practitioners were competent immediately after training (&lt;emph&gt;p&lt;/emph&gt; &amp;lt;.001).&lt;/p&gt; &lt;p&gt;Research from both high- and low-income countries has shown that although resuscitation skills and knowledge increase immediately following training, they eventually tend to deteriorate ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref50&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib18&quot; id=&quot;ref51&quot;&gt;18&lt;/reflink&gt;]). For instance, research carried out in Rwanda revealed that the competency of health professionals in newborn resuscitation had declined to an unacceptable degree 3 months after the training, suggesting that the training provided alone was inadequate to maintain their knowledge and expertise ([&lt;reflink idref=&quot;bib24&quot; id=&quot;ref52&quot;&gt;24&lt;/reflink&gt;]). Consequently, further evaluation of multimodal interventions is required to ensure that information is applied in clinical settings and to support the future midwifery task forces&#39; capability to retain resuscitation skills. The HBB program has been recognized globally for its effectiveness in improving neonatal outcomes. Arabi et al. ([&lt;reflink idref=&quot;bib1&quot; id=&quot;ref53&quot;&gt;1&lt;/reflink&gt;]) found that the introduction of HBB training in midwifery curricula led to significant improvements in students&#39; ability to perform key resuscitation steps. The program&#39;s focus on practical, hands-on training is particularly beneficial for students, helping them to retain and apply the skills in real-life scenarios. While there is evidence supporting the positive impact of the HBB program on student preparedness, gaps still exist. Although HBB training improves knowledge and skills, there is often a decline in proficiency over time without regular refresher courses ([&lt;reflink idref=&quot;bib2&quot; id=&quot;ref54&quot;&gt;2&lt;/reflink&gt;]). Also, students may face challenges in resource-limited settings where the ideal conditions for resuscitation (such as the availability of equipment) may not always be met.&lt;/p&gt; &lt;p&gt;In conclusion, fourth-year undergraduate midwifery students&#39; knowledge and skills in basic newborn resuscitation are significantly enhanced by exposure to the HBB program. However, the level of proficiency can vary based on the quality and frequency of training, as well as the opportunities for practical application. Continuous professional development and regular practice are essential to maintain and improve these critical skills. Therefore, it is essential to take into account the need to continuously improve midwives&#39; knowledge and skills through standalone HBB in-service training in partnership with the Ethiopian Midwives Association and relevant development partners both locally and internationally. Incorporating HBB training into the national structured curriculum would also ensure that students will receive formal education on neonatal resuscitation, which may not be consistently covered in all programs.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-17&quot;&gt;Strengths and Limitations of the Study&lt;/hd&gt; &lt;p&gt;These strengths and limitations should be considered when interpreting the findings of the study and their potential implications for midwifery education and neonatal care practices.&lt;/p&gt; &lt;hd id=&quot;AN0184162301-18&quot;&gt;Strengths of the Study&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;ulist&gt; &lt;item&gt; &lt;bold&gt; • _B_Relevant Population:&lt;/bold&gt; The study involves fourth-year midwifery students, who are likely to encounter situations requiring neonatal resuscitation in their future careers. This makes the findings directly applicable to their professional development and practice.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; • _B_Practical Skills Assessment:&lt;/bold&gt; Through evaluating the impact of HBB training on practical skills, the study offers valuable insights into the effectiveness of the training program in preparing students for real-world clinical scenarios.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; • _B_Potential for Long-Term Impact:&lt;/bold&gt; Training midwifery students in HBB has the potential to improve neonatal outcomes in the long term, as these students will carry these skills into their professional practice.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; • _B_Assessment Methodology:&lt;/bold&gt; The study&#39;s findings may be influenced by the specific assessment tools and methods used to evaluate the student&#39;s skills. The study used tools that are not validated or standardized by the WHO and the results accurately reflect the students&#39; competence.&lt;/item&gt; &lt;/ulist&gt; &lt;hd id=&quot;AN0184162301-19&quot;&gt;Limitations of the Study&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;ulist&gt; &lt;item&gt; &lt;bold&gt; • _B_Limited Generalizability:&lt;/bold&gt; The study&#39;s findings may be limited to the specific context of the institution where the training was conducted. Variations in resources, instructor quality, and student demographics across different institutions may affect the generalizability of the results.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; • _B_Short-Term Evaluation:&lt;/bold&gt; The study only assesses the immediate impact of the HBB training which may not capture long-term retention of skills or the actual application of these skills in clinical practice after graduation.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; • _B_Potential for Bias:&lt;/bold&gt; The study might be subject to bias as the assessment of skills is conducted by instructors who are also involved in delivering the training.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; • _B_Lack of Control Group:&lt;/bold&gt; Without a control group, it may be difficult to attribute improvements in skills or knowledge directly to the HBB training. The absence of a comparison group limits the ability to determine the effectiveness of the training relative to other methods.&lt;/item&gt; &lt;p&gt;&lt;/p&gt; &lt;item&gt; &lt;bold&gt; • _B_Resource-Intensive:&lt;/bold&gt; Implementing HBB training requires resources such as trained instructors, mannequins, and time within the curriculum. These resources may not be equally available across all educational institutions, limiting the study&#39;s applicability in resource-constrained settings.&lt;/item&gt; &lt;/ulist&gt; &lt;hd id=&quot;AN0184162301-20&quot;&gt;Supplemental Material&lt;/hd&gt; &lt;p&gt;Graph: Supplemental material, sj-pdf-1-sgo-10.1177_21582440251316932 for Effect of &quot;Helping Babies Breathe&quot; Training on Ethiopian Undergraduate Midwifery Students&#39; Knowledge and Skills in Neonatal Resuscitation at Public Universities: A Non-Randomized Quasi-Experimental Study by Endalew Gemechu Sendo, Girum Sebsibe Teshome, Wegnesh Kelbessa Jirata, Lemi Abebe Gebrewold and Rahel Endalew Gemechu in SAGE Open&lt;/p&gt; &lt;hd id=&quot;AN0184162301-21&quot;&gt;Supplemental Material&lt;/hd&gt; &lt;p&gt;Graph: Supplemental material, sj-pdf-2-sgo-10.1177_21582440251316932 for Effect of &quot;Helping Babies Breathe&quot; Training on Ethiopian Undergraduate Midwifery Students&#39; Knowledge and Skills in Neonatal Resuscitation at Public Universities: A Non-Randomized Quasi-Experimental Study by Endalew Gemechu Sendo, Girum Sebsibe Teshome, Wegnesh Kelbessa Jirata, Lemi Abebe Gebrewold and Rahel Endalew Gemechu in SAGE Open&lt;/p&gt; &lt;p&gt;This study was made possible through the generous funding provided by the Laerdal Foundation in Norway, for which we express our sincere gratitude. We also extend our thanks to the leadership of the College of Health Sciences, Addis Ababa University, for the technical support and dedication to the success of the project. Finally, we deeply appreciate the valuable contributions of the study participants, whose involvement was instrumental in the completion of this research.&lt;/p&gt; &lt;ref id=&quot;AN0184162301-22&quot;&gt; &lt;title&gt; Footnotes &lt;/title&gt; &lt;blist&gt; &lt;bibl id=&quot;bib1&quot; idref=&quot;ref53&quot; type=&quot;bt&quot;&gt;1&lt;/bibl&gt; &lt;bibtext&gt; Sendo, EG conceptualized and designed the study, and was the principal applicant for funding; he was also responsible for manuscript writing.GST, WKJ, and REG assisted in data collection, and LAG performed the data analysis. All authors read and approved the final manuscript.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib2&quot; idref=&quot;ref54&quot; type=&quot;bt&quot;&gt;2&lt;/bibl&gt; &lt;bibtext&gt; The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib3&quot; idref=&quot;ref11&quot; type=&quot;bt&quot;&gt;3&lt;/bibl&gt; &lt;bibtext&gt; The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Laerdal Foundation under grant number 2022-0192. However, the funding agency is not represented by the authors&#39; opinions in this publication.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib4&quot; idref=&quot;ref2&quot; type=&quot;bt&quot;&gt;4&lt;/bibl&gt; &lt;bibtext&gt; The Addis Ababa University, College of Health Sciences Institutional Review Board [IRB] provided an ethical letter (Protocol Number: 01/2023). Official contact was made with the appropriate office to request authorization to carry out the study. Each participant signed a voluntary written agreement form before the study. Anonymity and confidentiality of the data were also maintained.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib5&quot; idref=&quot;ref5&quot; type=&quot;bt&quot;&gt;5&lt;/bibl&gt; &lt;bibtext&gt; Not applicable&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib6&quot; idref=&quot;ref40&quot; type=&quot;bt&quot;&gt;6&lt;/bibl&gt; &lt;bibtext&gt; Endalew Gemechu Sendo&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibtext&gt;Graph https://orcid.org/0000-0001-7768-0196&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib7&quot; idref=&quot;ref41&quot; type=&quot;bt&quot;&gt;7&lt;/bibl&gt; &lt;bibtext&gt; All data relevant to the study are included in the article or uploaded as supplementary information.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib8&quot; idref=&quot;ref20&quot; type=&quot;bt&quot;&gt;8&lt;/bibl&gt; &lt;bibtext&gt; Supplemental material for this article is available online.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib9&quot; idref=&quot;ref13&quot; type=&quot;bt&quot;&gt;9&lt;/bibl&gt; &lt;bibtext&gt; Data Availability Statement included at the end of the article&lt;/bibtext&gt; &lt;/blist&gt; &lt;/ref&gt; &lt;ref id=&quot;AN0184162301-23&quot;&gt; &lt;title&gt; References &lt;/title&gt; &lt;blist&gt; &lt;bibtext&gt; Arabi A. 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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Foreign+Countries%22&quot;&gt;Foreign Countries&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Undergraduate+Students%22&quot;&gt;Undergraduate Students&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Obstetrics%22&quot;&gt;Obstetrics&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Birth%22&quot;&gt;Birth&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Neonates%22&quot;&gt;Neonates&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Infant+Care%22&quot;&gt;Infant Care&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Infant+Mortality%22&quot;&gt;Infant Mortality&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Program+Effectiveness%22&quot;&gt;Program Effectiveness&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Program+Implementation%22&quot;&gt;Program Implementation&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Academic+Achievement%22&quot;&gt;Academic Achievement&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Skill+Development%22&quot;&gt;Skill Development&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Public+Colleges%22&quot;&gt;Public Colleges&lt;/searchLink&gt;
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Ethiopia%22&quot;&gt;Ethiopia&lt;/searchLink&gt;
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/21582440251316932
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 2158-2440
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Helping Babies Breathe (HBB) is a global initiative launched by the American Academy of Pediatrics (AAP) in 2010, aimed at reducing neonatal mortality by addressing birth asphyxia, a leading cause of newborn deaths worldwide. The HBB training program trains providers in effectively resuscitating infants in developing countries, including Ethiopia. This study aims to examine the effects of HBB training on the knowledge and performance of undergraduate fourth-year midwifery students in neonatal resuscitation in public Ethiopian higher education institutions. The current study used a quasi-experimental study design. The study made use of the same research participants before and after the HBB Training. Pre- and post-knowledge tests, Objective structured clinical examinations (OSCEs), and a checklist for bag and mask ventilation skills checklist were used to assess the effectiveness of the HBB training. The data generated from pre and post-test results were imported into EPi Data version 4.0.2.49 and exported into SPSS version 25 for analysis. The data was correlated in nature due to its inherent source. After testing the assumptions, a paired t-test was used to examine the effect of HBB simulation training on the knowledge level of fourth-year midwifery students. The difference in the pre and post-training knowledge level of the students was declared as statistically significant at a p-value of .05. A total of 60 research participants from two public health science colleges that offer undergraduate midwifery training enrolled in this study; 54 of them received 2 days of HBB training in two phases and completed the pre- and immediate post-test course assessments. Six participants left the study for personal reasons. Of the participants in the study, 43 were female and 11 were male. The study participants were between the ages of 21 and 25, with a mean age of 22.47 years. The results demonstrated that, although before the intervention, over 25% of research participants (18; 29.63%) lacked adequate knowledge about managing birth asphyxia, all of them acquired adequate knowledge[[greater than or equal to]80%] after the intervention. T-tests after the HBB intervention also revealed a substantial improvement in knowledge [[d-bar] + SE: 2.09 + 2.13, p &lt; 0.001]. Similarly, following the HBB intervention, 43 research participants [or more than 3/4 of the sample] demonstrated appropriate skills [[greater than or equal to]80%] for neonatal resuscitation, according to the findings of the OSCE-A and OSCE-B psychomotor skill assessments. The HBB program is a lifesaving training program designed for low-income countries. The study&#39;s findings showed that the participants&#39; knowledge and skills of infant resuscitation were significantly improved by the HBB training course. The HBB training program has the utmost impact if pre-service refresher courses on neonatal resuscitation are offered to the midwife trainees before they join the national midwifery task forces.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1466997
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1466997
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/21582440251316932
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Obstetrics
        Type: general
      – SubjectFull: Birth
        Type: general
      – SubjectFull: Neonates
        Type: general
      – SubjectFull: Infant Care
        Type: general
      – SubjectFull: Infant Mortality
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Program Implementation
        Type: general
      – SubjectFull: Academic Achievement
        Type: general
      – SubjectFull: Skill Development
        Type: general
      – SubjectFull: Public Colleges
        Type: general
      – SubjectFull: Ethiopia
        Type: general
    Titles:
      – TitleFull: Effect of 'Helping Babies Breathe' Training on Ethiopian Undergraduate Midwifery Students' Knowledge and Skills in Neonatal Resuscitation at Public Universities: A Non-Randomized Quasi-Experimental Study
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      – PersonEntity:
          Name:
            NameFull: Endalew Gemechu Sendo
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            NameFull: Girum Sebsibe Teshome
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            NameFull: Wegnesh Kelbessa Jirata
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            NameFull: Lemi Abebe Gebrewold
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            NameFull: Rahel Endalew Gemechu
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            – D: 01
              M: 01
              Type: published
              Y: 2025
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            – Type: issn-electronic
              Value: 2158-2440
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              Value: 15
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              Value: 1
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            – TitleFull: SAGE Open
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