Factors influencing healthcare providers knowledge and skills retention following helping mothers survive and helping babies survive training in Tanzania: A mixed methods cross-sectional study

The Tanzanian Midwives Association (TAMA), in collaboration with development partners, implemented a project (50,000 Happy Birthdays) from 2018 to 2020 to improve providers knowledge and skills in saving lives at birth. The project was implemented under two training modules namely Helping Mothers Survive (HMS) and Helping Babies Survive (HBS). Through a mixed-methods cross-sectional design, knowledge retention was assessed by comparing follow-up and post-test knowledge scores among healthcare providers in the selected health facilities in Tanga, Geita, and Katavi regions. Four knowledge areas were evaluated using a written test and five skills areas were assessed using skills observation checklists for each. Quantitative data was analyzed using IBM SPSS version 25 by performing descriptive analysis, t-test and One-Way ANOVA with the level of significance determined at p< 0.05. Qualitative analysis was conducted through a thematic analysis approach and themes were generated to describe the factors influencing retention. 210 respondents participated in the study with more than half holding diploma (n=116; 55.2%) and working in urban area (n=123; 58.6%). There was a statistically significant drop in mean knowledge scores for controlling bleeding after birth (t=15.404, p<0.001), in helping babies breathe (t=8.580, p<0.001), and in essential care for small babies (t=19.620, p<0.001). Working in a rural area had a statistical significant higher drop in mean knowledge scores for managing pre-eclampsia (F=4.491, p=0.035) and for helping babies breathe (F=5.005, p=0.026). Education level also showed a significant difference in the mean knowledge score for managing pre-eclampsia (F=4.850, p=0.003). There was poor knowledge retention following receiving training on HMS and HBS. The level of professional education and residential area significantly influenced knowledge retention. Frequent refresher training and other relevant training among healthcare workers may be helpful in knowledge retention regarding maternal and neonatal care, with much emphasis on providers working in rural areas and those with lower level of professional education.