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Effect of Newborn Care Training on Essential Newborn Care Practices among Midwives in Nigeria

Abstract

Essential newborn care is critical to reducing preventable newborn illness and mortality, particularly during the first hours and days of life when newborns are highly vulnerable to complications. Midwives play a central role in providing immediate and routine newborn care, including thermal protection, early and exclusive breastfeeding support, infection prevention, cord care, newborn assessment, recognition of danger signs, and timely referral of sick newborns. However, gaps in knowledge, practical skills, adherence to standard protocols, workload, inadequate supervision, and limited access to continuing professional education may affect the quality of essential newborn care practices among midwives in Nigeria. Newborn care training provides an opportunity to strengthen healthcare workers' knowledge, clinical competencies, confidence, and adherence to evidence-based newborn care guidelines. Effective training may therefore improve the quality and consistency of essential newborn care practices and contribute to better newborn health outcomes. Against this background, this study investigates the effect of newborn care training on essential newborn care practices among midwives in Nigeria. The study will be anchored on Social Cognitive Theory, the Competency-Based Education Framework, and the Donabedian Model of Healthcare Quality. Social Cognitive Theory explains how knowledge, observational learning, self-efficacy, reinforcement, and the healthcare environment may influence midwives' adoption of appropriate newborn care practices. The Competency-Based Education Framework emphasizes the development and assessment of knowledge, practical skills, attitudes, and professional competencies required for effective newborn care. The Donabedian Model explains healthcare quality through structure, process, and outcome, with newborn care training representing an important input for improving the care process and essential newborn care practices serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how newborn care training may influence essential newborn care practices among midwives in Nigeria. The study will adopt a quantitative quasi-experimental research design. The study population will comprise registered midwives working in selected public and private hospitals, maternity centres, and primary healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, maternity units, and eligible midwives. Newborn care training will be assessed using indicators such as participation in newborn care training programmes, training frequency, duration and content of training, use of standardized newborn care guidelines, practical skills demonstrations, simulation exercises, competency assessments, refresher training, mentorship, supportive supervision, and access to newborn care educational materials. Essential newborn care practices will be assessed using indicators such as immediate newborn assessment, thermal protection, drying and warming, skin-to-skin care, early initiation of breastfeeding, appropriate cord care, infection prevention, hand hygiene, newborn identification, monitoring of vital signs, assessment for danger signs, appropriate newborn resuscitation where required, referral of sick newborns, documentation of newborn care, and adherence to relevant clinical protocols. Data will be collected using structured questionnaires, knowledge assessment tools, clinical observation checklists, training records, maternity registers, newborn care records, supervision reports, and healthcare facility documents. Descriptive statistics will be used to summarize midwives' demographic and professional characteristics, training exposure, knowledge levels, and newborn care practices. Inferential statistical techniques, including paired-sample tests, chi-square tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of newborn care training on essential newborn care practices. Where a quasi-experimental design is adopted, midwives' knowledge and observed practices before and after training may be compared. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that newborn care training has a significant positive effect on essential newborn care practices among midwives in Nigeria. Midwives who receive structured and competency-based newborn care training are expected to demonstrate improved knowledge, practical skills, confidence, and adherence to recommended essential newborn care procedures compared with their pre-training performance or midwives without equivalent training exposure. Training that combines theoretical instruction with practical demonstrations, simulations, competency assessments, and supportive supervision may be particularly effective in improving clinical practice. Improved newborn care practices may contribute to timely recognition of danger signs, appropriate management of common newborn problems, better breastfeeding support, improved infection prevention, and more effective referral of sick newborns. However, staff shortages, heavy workloads, inadequate equipment, limited training opportunities, poor supervision, and inconsistent availability of essential newborn care supplies may limit the translation of training into routine clinical practice. The study therefore expects regular, practical, competency-based, and adequately supported newborn care training to contribute significantly to improved essential newborn care practices among midwives in Nigeria. The study is expected to contribute to the literature on newborn care training, essential newborn care practices, midwifery practice, maternal and newborn health, neonatal care, healthcare worker training, quality of maternity services, and public health in Nigeria. 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, hospital management boards, maternity facilities, midwifery institutions, professional bodies, development partners, and policymakers regarding strategies for improving newborn care quality. The study will also provide evidence-based recommendations for strengthening competency-based newborn care training, expanding refresher training programmes, integrating simulation and practical skills assessment into training, strengthening mentorship and supportive supervision, improving access to newborn care guidelines and equipment, monitoring adherence to essential newborn care standards, and integrating continuous newborn care education into routine professional development programmes for midwives across Nigeria.

Keywords: Newborn care training, essential newborn care practices, midwives, neonatal care, maternal and newborn health, newborn health, midwifery practice, healthcare worker training, neonatal safety, Nigeria, public health.