Impact of On-Site Training of Neonatal Resuscitation Techniques in Shirati District Hospitals: Does On-Site Training Improve Knowledge, Attitude, and Practices?

Program/Project Purpose: In Tanzania, early neonatal morality remains high despite the county’s efforts towards improving health indicators. It’s estimated that birth asphyxia is involved in up to 30% of early neonatal deaths in developing countries, and is associated with high neurological morbidity for those who survive. Early interventions targeting birth asphyxia were not successful; likely due to low national priority, limited resources, and targeting limited types of providers. Helping Babies Breath (HBB) is an evidence-based neonatal resuscitation program designed for resource- limited settings. The program follows a basic intervention approach which emphasizes the importance of skilled attendants at every birth. The HBB program has been successfully implemented at eight sites within Tanzania, and has been endorsed by the Tanzanian National Government. However studies in Tanzania have been carried at referral and teaching hospitals and not at a District hospital. The purpose of this study was to examine the effectiveness of teaching HBB at the level of a District Hospital. The project took place June 2014. Structure/Method/Design: This is a prospective two-phase program evaluation to assess whether on-site training can improve knowledge, 26 Education/Training/Capacity Building attitude, and practices at a District Hospital in Shirati, Tanzania. Medical students from Touro University—California were trained as instructors for HBB curriculum. During phase 1, students designed pre- and post-surveys to measure whether the training sessions could improve knowledge and attitudes about HBB interventions. Presurveys were administered just prior to the training sessions, and post surveys were administered at the end of the training sessions. Participants included hospital labor & delivery staff. A total of 112 sets of surveys were completed during 4 training sessions. In addition, baseline data of birth outcomes were collected from delivery log books. Phase 2 of data collection will take place June 2015, and the new data will determine whether trainings effectively improved practices. Additional trainings will also be conducted at this time. Outcomes & Evaluation: Results indicate that the trainings were effective, and scores reflecting knowledge and attitudes were improved in the post-surveys. Practices will be evaluated during phase 2. Going Forward: The goal of this study was to determine if the training of District Hospital’s labor and delivery staff improves knowledge and attitudes. Results show that HBB can be implemented effectively in this setting. An ongoing challenge for this program includes language barriers. Although staff could speak English, comprehension levels varied, and some participants had difficulty understanding both the presentation and the survey questions. In future trainings, surveys should be re-written using basic sentence structure, and word choice should be considered

CASPASE-12 and Rheumatoid Arthritis in African-Americans

CASPASE-12 (CASP12) has a downregulatory function during infection and thus may protect against inflammatory disease. We investigated the distribution of CASP12 alleles (#rs497116) in African-Americans (AA) with rheumatoid arthritis (RA). CASP12 alleles were genotyped in 953 RA patients and 342 controls. Statistical analyses comparing genotype groups were performed using Kruskal–Wallis non-parametric ANOVA with Mann–Whitney U tests and chi-square tests. There was no significant difference in the overall distribution of CASP12 genotypes within AA with RA, but CASP12 homozygous patients had lower baseline joint-narrowing scores. CASP12 homozygosity appears to be a subtle protective factor for some aspects of RA in AA patients