A blended curriculum to improve student community health officers’ competencies in newborn infection prevention and control

Figures & data

Table 1. Developed curriculum on newborn infection prevention and control.

Curriculum goal: To develop student community health officers’ (CHOs) knowledge of, skills in and attitudes towards newborn infection prevention and control through a blended education program.
Module	Unit	Video topics	Practical session
Newborn and infections.	The healthy newborn.	Identification of a normal newborn. Role of CHOs in newborn care.	Demonstration of examination of a newborn in class using a newborn model.
	The problem of infections in the newborn.	Epidemiology of newborn infections. Source of infections in the newborn.	None
Prevention and control of infections in the newborn.	Prevention of newborn infections in the health facility.	Infection prevention and control: care of the newborn in the health facility. Standard precautions: hand hygiene and personal protective equipment. Environment of care in the health facility.	Handwashing technique using soap and water and alcohol hand rub. Donning and doffing of personal protective equipment. Preparation of chlorine solution for disinfection. Waste management.
	Prevention of newborn infections in the community.	Care of the newborn in the community. Environment of care in the community. Counseling on newborn infection to mothers and families.	Pair up with a class member and role play the care of a newborn during a postnatal visit to a mother at home. Role-play of health education to community members on environmental hygiene to prevent newborn infections. Pair up with a class member and role play a counseling session on newborn infection prevention to a mother or caregiver.
Care of infections in the newborn.	Care of newborn infections by community health officers.	CHO’s response to newborn infections. Managing severe infections in the newborn.	Pair up with a class member and role play response to newborn infection during a home visit with a mother of a newborn with signs of illness.
	The referral process.	Referral of a sick baby.	None

Table 2. Pre- and post-course knowledge of newborn infection prevention and control.

Questions and correct options	Pre-course (N = 69)		Post-course (N = 69)		p-value
	Frequency (%)	Mean score (95% CI)	Frequency (%)	Mean score (95% CI)
1. What is the newborn period of a baby’s life?	29 (42.03)	0.42 (0.30–0.54)	36 (52.17)	0.52 (0.40-0.64)	0.211
First 4 weeks.
2. What makes newborn babies prone to infection?	55 (79.71)	0.80 (0.70–0.89)	63 (91.30)	0.91 (0.84-0.98)	0.045
Immature immune system.
3. Which is a symptom of infection in a newborn baby?	5 (7.25)	0.07 (0.01–0.14)	9 (13.04)	0.13 (0.05-0.21)	0.251
Being very sleepy.
4. What is the main source by which germs are transmitted to newborns at the health facility and at home?	48 (69.57)	0.70 (0.58–0.81)	59 (85.51)	0.86 (0.77-0.94)	0.007
Hands.
5. Which infection can pass from the mother to the baby in the womb?	15 (21.74)	0.22 (0.12–0.32)	35 (50.72)	0.51 (0.39-0.63)	<0.001
Rubella.
6. Which infection can pass from the mother to the baby in the birth canal during delivery?	18 (26.09)	0.26 (0.15–0.37)	29 (42.03)	0.42 (0.30-0.54)	0.027
Conjunctivitis.
7. What are standard precautions?	24 (34.78)	0.35 (0.23–0.46)	34 (49.28)	0.49 (0.37-0.61)	0.077
Work practices of infection prevention and control.
8. At what point should hands be cleaned when caring for a newborn baby?	45 (65.22)	0.65 (0.54–0.77)	61 (88.41)	0.88 (0.81-0.96)	0.001
After touching the environment around a newborn.
9. Which is a standard precaution in newborn care?	27 (39.13)	0.39 (0.27–0.51)	32 (46.38)	0.46 (0.34-0.58)	0.278
Sterilization of reusable instruments.
10. In what way can hands get contaminated?	63 (91.30)	0.91 (0.84–0.98)	67 (97.10)	0.97 (0.93-1.01)	0.159
Environmental surfaces.
11. What can be done to prevent infection of wounds/incisions?	63 (91.30)	0.91 (0.84–0.98)	59 (85.51)	0.86 (0.77-0.94)	0.251
Single use of medical devices.
12. What is a possible cause of bloodborne infections?	38 (55.07)	0.55 (0.43–0.67)	50 (72.46)	0.72 (0.62-0.83)	0.018
Contaminated needles.
13. What is a good way to disinfect water for general care of the newborn?	26 (37.68)	0.38 (0.26–0.49)	42 (60.87)	0.61 (0.49-0.73)	0.004
Put chlorine in the water for at least 30 min.
14. What is a way to prevent newborn infections in the health facility?	26 (37.68)	0.38 (0.26–0.49)	30 (43.48)	0.43 (0.31-0.55)	0.418
Judicious use of antibiotics.
15. What should be applied to the newborn’s umbilical cord to prevent infection?	67 (97.10)	0.97 (0.93–1.01)	69 (100.00)	1.00	0.159
Chlorhexidine gel.
16. What activity is most important within the first hour of a newborn’s life?	50 (72.46)	0.72 (0.62–0.83)	42 (60.87)	0.61 (0.49-0.73)	0.103
Initiate breastfeeding.
17. Which is a non-infectious health care waste?	58 (84.06)	0.84 (0.75–0.93)	64 (92.75)	0.93 (0.86-0.99)	0.083
Paper.
18. What is the correct order for household water treatment?	22 (31.88)	0.32 (0.21–0.43)	29 (42.03)	0.42 (0.30-0.54)	0.211
Source protection, sedimentation, filtration, disinfection, safe storage.
19. What is the correct order of putting on personal protective equipment?	20 (28.99)	0.29 (0.18–0.40)	47 (68.12)	0.68 (0.57-0.79)	<0.001
Hand hygiene, put on apron, put on mask, put on gloves.
20. What is the correct order of removing personal protective equipment?	39 (56.52)	0.56 (0.45–0.69)	57 (82.61)	0.83 (0.73-0.92)	<0.001
Remove gloves, remove apron, remove mask, hand hygiene.
Overall Knowledge		10.70 (10.15–11.24) 53.5%		13.25 (12.65-13.84) 66.5%	<0.001
Mean knowledge score %

CI: Confidence Interval.

Table 3. Pre- and post-course skills in newborn infection prevention and control.

	Pre-course (N = 63)	Post-course (N = 63)
OSCE stations	Mean score (95% CI)	Mean score (95% CI)	p-value
1. Handwashing	4.28 (4.07-4.49)	5.08 (4.80–5.35)	<0.001
2. Counseling on Newborn Infection Prevention to Mothers	4.53 (4.03-5.04)	6.87 (6.28–7.47)	<0.001
3. Disinfection	2.44 (2.11-2.78)	8.28 (7.55–9.00)	<0.001
4. Examination of the newborn	5.43 (4.86-6.00)	7.52 (6.97–8.06)	<0.001
5. Waste Management	2.35 (2.13-2.57)	2.94 (2.88–2.99)	<0.001
6. Donning and doffing of PPE	2.34 (2.00-2.48)	4.05 (3.81–4.28)	<0.001
Overall skill	21.27 (20.20-22.34)	34.73 (33.37–36.09)	<0.001
Mean score %	36.4%	59.3%

CI: Confidence Interval.

Table 4. Pre- and post-course attitude towards newborn infection prevention and control.

	Pre-course (N = 69)	Post-course (N = 69)
Statements	Mean score (95% CI)	Mean score (95% CI)	p-value
1. It is important to prevent infections in the newborn.	6.83 (6.64-7.01)	6.78 (6.55–7.01)	0.763
2. I am concerned about infections in the newborn.	6.43 (6.16-6.70)	6.52 (6.28–6.76)	0.594
3. I do not have to wash my hands if I use gloves.	6.16 (5.85-6.47)	6.55 (6.33–6.77)	0.044
4. Guidelines on newborn infection prevention control should be adhered to at all times.	6.61 (6.35-6.86)	6.59 (6.36–6.83)	0.911
5. I have enough knowledge on newborn infection prevention and control.	5.39 (5.07-5.71)	6.00 (5.68–6.32)	0.003
6. I should attend in-service training/workshop related to newborn infection prevention and control regularly.	6.55 (6.33-6.77)	6.54 (6.29–6.78)	0.919
7. I should wash my hands before and after touching newborn babies.	6.64 (6.44-6.84)	6.67 (6.47–6.87)	0.831
8. I feel confident in my ability to counsel mothers and caregivers on newborn infection prevention.	6.19 (5.95-6.42)	6.55 (6.41–6.69)	0.003
9. Newborn infection prevention and control is not my responsibility.	6.51 (6.28-6.73)	6.42 (6.11–6.74)	0.639
10. Training on newborn infection prevention and control is relevant to my work practice.	6.78 (6.59-6.97)	6.55 (6.31–6.79)	0.117
Overall attitude	63.99 (62.41-65.56)	65.17 (63.68–66.67)	0.222
Mean attitude score %	91.4%	93.1%

CI: Confidence Interval.

Table 5. Course satisfaction scores of students (n = 69).

Item	Mean score (95% CI)
1. Class assignments were clearly communicated to me during the video learning.	6.29 (6.15–6.43)
2. Feedback and other assignments were given in a timely manner during the video learning.	6.14 (6.00–6.29)
3. The instructor makes me feel that I am part of the video learning class and belong.	6.12 (5.89–6.34)
4. I am satisfied with the accessibility and availability of the instructor during my video learning.	6.23 (6.06–6.41)
5. I am satisfied with how I am able to navigate within the video learning modules.	6.06 (5.84–6.27)
6. I am satisfied with download times of the videos for learning.	5.74 (5.46–6.01)
7. I am satisfied with the frequency I have to watch the videos.	6.12 (5.88–6.35)
8. I am satisfied with the flexibility this video learning affords me.	5.96 (5.59–6.32)
9. I am satisfied with the level of self-directedness I am given in this video learning.	6.06 (5.84–6.27)
10. I am satisfied with how much I enjoy working on the video learning by myself.	6.22 (6.02–6.41)
11. I am satisfied with the quality of interaction between all involved parties during the video learning.	6.17 (5.98–6.37)
12. I am satisfied with the process of collaboration activities during the video learning.	6.26 (6.10–6.42)
13. I am satisfied with how much I could relate to the other students during the video learning.	5.88 (5.60–6.17)
14. I am satisfied with how comfortable with participating I became.	6.28 (6.13–6.42)
15. I am satisfied with the level of effort this video learning course required.	5.97 (5.62–6.31)
16. I am satisfied with my performance in this video learning course.	5.93 (5.64–6.21)
17. I am satisfied with how I am able to apply what I have learned in this video learning course.	6.26 (6.07–6.45)
18. I am satisfied enough with this video learning course and can recommend it to others.	6.20 (6.01–6.39)
19. Compared to other course settings, I am more satisfied with this video learning experience.	5.77 (5.50–6.04)
20. My level of satisfaction in this video learning course would encourage me to enroll in another course in this setting.	5.96 (5.66–6.25)
21. Overall, I am satisfied with this video learning course.	6.23 (6.01–6.45)

CI: Confidence Interval.

Table 6. Mean course satisfaction scores according to subscales.

Subscales	Mean score (95% CI)	Mean score %
Instructor (Items 1 – 4)	24.78 (24.26–25.30)	88.68
Technology (Items 5 – 6)	11.79 (11.38–12.22)	84.50
Set-up (Items 7 – 10)	24.35 (23.52–25.18)	87.07
Interaction (Items 11 – 14)	24.59 (23.97–25.22)	87.89
Outcome (Items 15 – 17)	18.16 (17.47–18.84)	86.48
Overall (Items 18 – 21)	24.16 (23.33–24.99)	86.29
Total satisfaction score (Items 1 – 21)	127.84 (124.97–130.89)	87.05

CI: Confidence Interval.

Table 7. Illustrative quotes for themes.

Theme 1 - Perception of content of the videos.
‘It’s educative, it’s interactive and it was as if am in class with the lecturer.’ (Participant 1, year one)
‘The video is short and precise! The message they were trying to pass across is very clear and the facilitators are very accessible’. (Participant 11, year one)
‘The way the lecture has been presented in the video is very interesting to the extent that it has add(ed) a lot of knowledge to me. It has improved my skill because there were a lot of things we learnt. The way we are doing it before is quite different from what we saw on the video’. (Participant 12, year two)
‘At my leisure time, I go back to watch the video again, watch again and see the procedures, especially that area of hand washing that the lecturer was carrying out the procedure practically… it was good. The lecturer was demonstrating the procedure of normal hand wash as if it was real’. (Participant 5, year one)
Theme 2 - Motivation for video learning.
What really motivated me was that I wanted to know more. I wanted to go into it and know more about the lecture. That’s what really motivated me and I know that going through it can…it is always available for me to go back and watch and watch and watch again, so that’s what really motivated me.’ (Participant 3, year one)
‘The facilitators made me to be interested in the videos because whenever I’m going back to watch the video… I’m happy that they said if we have any challenge we can call them, chat with them privately…they will answer us. They do everything that motivated me on that video’. (Participant 3, year one)
‘The people that taught us in the video and the content of the video were taken by different lecturers.’ (Participant 6, year two)
‘The kind of topics that they brought on board I knew is something that every health worker or anybody working in health line should know, I wanted to know more about the topic and after knowing more, it will help boost my self-confidence and self-esteem. I know for sure that doctors from LUTH came down to train us how to prevent infection in newborn and then I won’t be scared of anything like infection, if I come across any infection in newborn. That was my motivation.’ (Participant 9, year two)
Theme 3: Satisfaction with the course.
‘Very satisfied… I’ll say 95 percent! I can recommend the video for someone else because it is very educative, it serves the purpose of the education and is very interactive. It brings about the passion of the teacher and people can learn a lot from it’. (Participant 2, year one)
‘Well on a scale of 1-10, I will give it 8 over 10 because I can always learn at my own convenient time.’ (Participant 5, year one)
‘Very, very (satisfied)… at least 80/85 percent! Because it is very well explanatory.’ (Participant 8, year two)
‘Eeeerh…I give 99.9 percent! Yeeees! I can recommend it in which I’ve done already…. So I sent it to my boss and she was so happy that something like that is coming up in our…in our profession because we’re trying to….to project our profession in a…in a such a way that people will know that these people, these people are coming up!’ (Participant 6, year two)
Theme 4: Challenges experienced during the course.
‘It is data consuming. When I started it was consuming my data, in fact I had to buy another one (data) before I realized that we should…. maybe I should download and all of that. Then I was having challenge with memory like it cannot download. I have to watch it online, and it was data consuming’. (Participant 1, year one)
‘The constraints where those links were not well-labelled also when there was no light (electricity)’. (Participant 7, year two)
‘It was effective but the only constraint I had is that there was no network for downloading …… I had to collect from my colleagues through Bluetooth on my laptop, so after that, I didn’t have any problem.’ (Participant 8, year two)
‘The lecturer would not be able to give you the feedback at the time (of watching videos)… So, it will be later before we receive feedback.’ (Participant 4, year two)
Theme 5: Recommendations for course improvement.
‘This one (videos) they did now is self-explanatory but more of it should be more communicated in practical form……. that’s what I’m talking about, the practical issue, that it should be more of practical’. (Participant 5, year one)
‘Another improvement that we want to see in the next video teaching is that the next one should be more of pictures of those infections in babies.’ (Participant 12, year two)
‘All other courses should be introduced into video learning because we all know this is an adult school and many of our people… many of our students…they are civil servants. The video learning can help many of them.’ (Participant 6, year two)
‘I don’t know maybe the school management or government can also help in subsidizing for data fee like providing Wi-Fi for us at a reduced fee, so that we’ll not be spending too much after paying school fees and still be spending too much money on data.’ (Participant 10, year two)

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, MB. The data are not publicly available due to their containing information that could compromise the privacy of research participants.