{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:32Z","timestamp":1782107372636,"version":"3.54.5"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The Tanzanian Midwives Association (TAMA), in collaboration with development partners, implemented the\n                      <jats:italic>50,000 Happy Birthdays<\/jats:italic>\n                      project (2018\u20132020) to improve healthcare providers' knowledge and skills in saving lives at birth through the\n                      <jats:italic>Helping Mothers Survive<\/jats:italic>\n                      (HMS) and\n                      <jats:italic>Helping Babies Survive<\/jats:italic>\n                      (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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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,\n                      <jats:italic>t<\/jats:italic>\n                      -tests, and one-way ANOVA, with significance set at\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05. Thematic analysis was applied to qualitative data to identify factors influencing knowledge and skills retention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 210 respondents participated; over half held diplomas (\n                      <jats:italic>n<\/jats:italic>\n                      = 116; 55.2%) and worked in urban areas (\n                      <jats:italic>n<\/jats:italic>\n                      = 123; 58.6%). The largest knowledge decline was observed in pre-eclampsia management (\u221221.0 points), followed by essential care for small babies (\u221214.7), controlling bleeding after birth (\u221212.5), while helping babies breathe showed the smallest decline (\u22127.7). Skills also showed significant reductions across all domains, with the greatest decline in administration of magnesium sulfate (\u221217.1) and active man-agement of the third stage of labor (\u221217.0). Rural providers showed greater declines in key obstetric skills: manual removal of the placenta and active management of the third stage of labor (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). One-way ANOVA showed that professional education level was significantly associated with knowledge retention only for pre-eclampsia management [F\n                      <jats:sub>(2, 205)<\/jats:sub>\n                      = 6.919,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001, \u03a9\n                      <jats:sup>2<\/jats:sup>\n                      = 0.049]. A significant difference in skills decline was also observed for nasogastric tube feeding across education levels [F\n                      <jats:sub>(2, 205)<\/jats:sub>\n                      = 3.601,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.029, \u03a9\n                      <jats:sup>2<\/jats:sup>\n                      = 0.020].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Knowledge and skills retention declined significantly over time. Regular refresher training is recommended, particularly for rural healthcare providers and those with lower educational qualifications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1824835","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:40:17Z","timestamp":1782106817000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term knowledge and skills retention following Helping Mothers Survive and Helping Babies Survive training in Tanzania: a mixed-methods follow-up study"],"prefix":"10.3389","volume":"14","author":[{"given":"Beatrice Erastus","family":"Mwilike","sequence":"first","affiliation":[{"name":"Department of Midwifery, Child and Reproductive Health, Muhimbili University of Health and Allied Sciences","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchius","family":"Philbert","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Muhimbili National Hospital","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Rimoy","sequence":"additional","affiliation":[{"name":"Tanzania Midwives Association (TAMA) Headquarters","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Mabada","sequence":"additional","affiliation":[{"name":"Tanzania Midwives Association (TAMA) Headquarters","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicodem","family":"Komba","sequence":"additional","affiliation":[{"name":"Tanzania Midwives Association (TAMA) Headquarters","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Okade","sequence":"additional","affiliation":[{"name":"Department of Disease Control and Environmental Health, Makerere University School of Public Health","place":["Kampala, Uganda"]},{"name":"Elevate Research and Health Services Limited","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feddy","family":"Mwanga","sequence":"additional","affiliation":[{"name":"Tanzania Midwives Association (TAMA) Headquarters","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid","family":"Gosse","sequence":"additional","affiliation":[{"name":"Department of Midwifery, Child and Reproductive Health, Muhimbili University of Health and Allied Sciences","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Ambikile","sequence":"additional","affiliation":[{"name":"Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"B1","unstructured":"WHO\n          \n          WHO Trends in maternal mortality 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division\n          \n          2025"},{"key":"B2","unstructured":"Newborn mortality\n          \n          2024"},{"key":"B3","unstructured":"Neonatal mortality\n          \n          2025"},{"key":"B4","unstructured":"Maternal and Perinatal Death Surveillance and Response (MPDSR) Report for Six Years (2018\u20132023).\n          \n          2025"},{"key":"B5","unstructured":"MIS\n              T\n            \n         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high-frequency plus mobile mentoring versus traditional group-based trainings among health workers on day of birth care in Nigeria; A cluster randomized controlled trial","volume":"20","author":"Ugwa","year":"2020","journal-title":"BMC Health Serv Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s41077-025-00338-2","article-title":"Neonatal resuscitation skills acquisition among healthcare providers after Helping Babies Breathe simulation training using improved tools across two regions in Tanzania","volume":"10","author":"Kalabamu","year":"2025","journal-title":"Adv Simul."},{"key":"B13","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s40748-025-00201-2","article-title":"Retention of knowledge and skills among midwives one year after completing helping babies breathe pre-service training in Ethiopia: a non-randomized quasi-experimental study","volume":"11","author":"Sendo","year":"2025","journal-title":"Matern Heal Neonatol Perinatol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1186\/s12884-025-07590-4","article-title":"Improving Tanzanian student nurse-midwives' knowledge, skills and attitude in postpartum hemorrhage prevention through simulation-based education: a pre-post quasi experimental study","volume":"25","author":"Faustine","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"B15","doi-asserted-by":"publisher","first-page":"103617","DOI":"10.1016\/j.nepr.2023.103617","article-title":"Factors of cardiopulmonary resuscitation skills retention among healthcare providers: a scoping review","volume":"69","author":"Junli","year":"2023","journal-title":"Nurse Educ Pract."},{"key":"B16","doi-asserted-by":"crossref","unstructured":"Matovelo\n              D\n            \n            \n              Brenner\n              JL\n            \n            \n              Singhal\n              N\n            \n            \n              NettelAguirre\n              A\n            \n            \n              Ndaboine\n              E\n            \n            \n              Shabani\n              G\n            \n          \n          A low resource simulation-based training package leads to increased knowledge and skill retention post Basic Emergency Obstetric and Neonatal Care in rural Tanzania: A Quasi-experimental research design\n          \n          2024","DOI":"10.21203\/rs.3.rs-4560296\/v1"},{"key":"B17","doi-asserted-by":"publisher","first-page":"104847","DOI":"10.1016\/j.ijnurstu.2024.104847","article-title":"Evaluating a clinical mentorship intervention on maternal and neonatal complications in primary health facilities in Blantyre district, Malawi: a longitudinal analysis of the Global Action in Nursing program","volume":"158","author":"Blair","year":"2024","journal-title":"Int J Nurs Stud."}],"container-title":["Frontiers in Public 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