Long-term knowledge and skills retention following Helping Mothers Survive and Helping Babies Survive training in Tanzania: a mixed-methods follow-up study

Abstract

Background The Tanzanian Midwives Association (TAMA), in collaboration with development partners, implemented the 50,000 Happy Birthdays project (2018–2020) to improve healthcare providers' knowledge and skills in saving lives at birth through the Helping Mothers Survive (HMS) and Helping Babies Survive (HBS) training modules. Despite large-scale implementation of HMS and HBS training in Tanzania, limited evidence exists on long-term retention of knowledge and skills across multiple modules and on contextual determinants influencing sustainability. Methods A mixed-methods cross-sectional design was used to assess knowledge and skills retention by comparing post-test and follow-up test scores among providers in selected health facilities in the Tanga, Geita, and Katavi regions. Four knowledge areas were evaluated using written tests, and five skill areas were assessed using observational checklists. Quantitative data were analyzed using IBM SPSS version 25, employing descriptive statistics, t -tests, and one-way ANOVA, with significance set at p < 0.05. Thematic analysis was applied to qualitative data to identify factors influencing knowledge and skills retention. Results A total of 210 respondents participated; over half held diplomas ( n = 116; 55.2%) and worked in urban areas ( n = 123; 58.6%). The largest knowledge decline was observed in pre-eclampsia management (−21.0 points), followed by essential care for small babies (−14.7), controlling bleeding after birth (−12.5), while helping babies breathe showed the smallest decline (−7.7). Skills also showed significant reductions across all domains, with the greatest decline in administration of magnesium sulfate (−17.1) and active man-agement of the third stage of labor (−17.0). Rural providers showed greater declines in key obstetric skills: manual removal of the placenta and active management of the third stage of labor ( p < 0.05). One-way ANOVA showed that professional education level was significantly associated with knowledge retention only for pre-eclampsia management [F (2, 205) = 6.919, p = 0.001, Ω 2 = 0.049]. A significant difference in skills decline was also observed for nasogastric tube feeding across education levels [F (2, 205) = 3.601, p = 0.029, Ω 2 = 0.020]. Conclusions Knowledge and skills retention declined significantly over time. Regular refresher training is recommended, particularly for rural healthcare providers and those with lower educational qualifications.