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Effect of Newborn Resuscitation Education on Neonatal Resuscitation Knowledge among Midwives in Nigeria

Abstract

Neonatal complications during and immediately after birth remain an important public health concern, particularly because failure to establish effective breathing at birth can rapidly lead to severe morbidity or death when appropriate intervention is delayed. Midwives play a critical role in the immediate care of newborns because they are frequently responsible for assessing newborns at birth, identifying those who require assistance, initiating basic resuscitation measures, and facilitating referral or advanced care when necessary. Newborn resuscitation education provides midwives with knowledge and practical skills relating to preparation for birth, rapid assessment of the newborn, recognition of ineffective breathing or apnoea, provision of initial newborn care, ventilation, chest compressions when indicated, appropriate use of resuscitation equipment, teamwork, communication, and escalation of care. Neonatal resuscitation knowledge refers to midwives' understanding of the principles, procedures, indications, sequence, and appropriate techniques involved in the assessment and resuscitation of newborns who require assistance at birth. In Nigeria, inadequate access to regular neonatal resuscitation training, limited opportunities for skills reinforcement, shortages of appropriate resuscitation equipment, high workloads, staff shortages, and variations in adherence to established neonatal resuscitation protocols may affect the capacity of midwives to respond appropriately to newborn emergencies. Effective newborn resuscitation education may improve midwives' knowledge, clinical decision-making, confidence, and preparedness to provide timely neonatal resuscitation. Against this background, this study investigates the effect of newborn resuscitation education on neonatal resuscitation knowledge among midwives in Nigeria. The study is anchored on Social Cognitive Theory, the Knowledge-Attitude-Practice framework, and Experiential Learning Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare professionals' clinical behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how structured newborn resuscitation education can improve knowledge and preparedness for neonatal emergency care. Experiential Learning Theory emphasizes learning through practical experience, simulation, reflection, and application, making it particularly relevant to skills-based neonatal resuscitation education. Collectively, these theoretical perspectives provide a suitable framework for explaining how newborn resuscitation education may influence neonatal resuscitation knowledge among midwives in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from midwives providing maternity and newborn care in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire and a standardized neonatal resuscitation knowledge assessment. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, maternity units, and eligible midwives. Where feasible, selected healthcare facilities or midwife groups will be assigned to intervention and comparison groups. Midwives in the intervention group will receive structured newborn resuscitation education covering preparation for newborn resuscitation, rapid assessment at birth, recognition of ineffective breathing or apnoea, initial newborn care, ventilation, chest compressions when indicated, appropriate use and checking of resuscitation equipment, teamwork, communication, and escalation or referral procedures. Neonatal resuscitation knowledge will be assessed using indicators such as knowledge of newborn assessment, identification of newborns requiring resuscitation, correct sequence of resuscitation steps, indications for ventilation and chest compressions, appropriate use of resuscitation equipment, and recognition of situations requiring escalation or referral. Where feasible, case scenarios and structured knowledge questions will be incorporated to assess the application of knowledge to neonatal emergency situations. Descriptive statistics will be used to summarize midwives' sociodemographic and professional characteristics, previous resuscitation training, exposure to newborn resuscitation education, and neonatal resuscitation knowledge scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the effect of newborn resuscitation education on neonatal resuscitation knowledge. Where appropriate, pre-intervention and post-intervention knowledge scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that newborn resuscitation education has a significant positive effect on neonatal resuscitation knowledge among midwives in Nigeria. Midwives exposed to structured newborn resuscitation education are expected to demonstrate improved knowledge of newborn assessment, recognition of breathing difficulties, appropriate resuscitation sequences, ventilation, chest compressions when indicated, use of resuscitation equipment, and escalation procedures. Education may also improve midwives' understanding of the importance of timely intervention and appropriate preparation before every delivery. Regular education and skills reinforcement may strengthen knowledge retention and preparedness for neonatal emergencies. However, education alone may not guarantee effective neonatal resuscitation performance because midwives may continue to face barriers such as inadequate resuscitation equipment, shortages of trained personnel, heavy workloads, inadequate supervision, limited opportunities for skills practice, and poor access to referral or advanced neonatal care. Consequently, newborn resuscitation education is expected to be most effective when supported by regular simulation-based training, appropriate resuscitation equipment, clinical supervision, skills assessment, continuing professional development, and functional newborn emergency referral systems. The study is expected to contribute to the literature on neonatal resuscitation, newborn health, midwifery education, neonatal emergency care, maternal and child health, healthcare worker capacity, clinical training, and public health in Nigeria by providing empirical evidence on the effect of newborn resuscitation education on neonatal resuscitation knowledge among midwives. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nursing and Midwifery Council of Nigeria, state ministries of health, hospitals, maternity facilities, nursing and midwifery training institutions, professional associations, maternal and newborn health programmes, development partners, and policymakers regarding strategies for strengthening neonatal emergency care capacity. The study will also provide evidence-based recommendations for integrating regular newborn resuscitation education and simulation training into midwifery continuing professional development, strengthening neonatal resuscitation preparedness, ensuring availability of essential resuscitation equipment, improving clinical supervision and competency assessment, and enhancing the capacity of midwives to provide timely and appropriate neonatal resuscitation in Nigeria.

Keywords: Newborn resuscitation education, neonatal resuscitation knowledge, midwives, neonatal resuscitation, newborn health, neonatal emergency care, midwifery education, maternal and child health, clinical training, newborn emergency care, healthcare worker education, public health, Nigeria.