Long-Term Effect of Simulation-Based Education on Knowledge Retention in Initial Neonatal Care Among Nurse-Midwives in Kilimanjaro, Tanzania: A Quasi-Experimental Study

Background: Although simulation-based education is reported to improve nursing and midwifery students’ clinical competencies, evidence regarding knowledge retention remains limited, particularly in low-resource settings. This study evaluated two-year knowledge retention following simulation-based education in initial neonatal care among nurse-midwives in Tanzania. Methods: This is a two-year follow-up of a quasi-experimental study conducted in June 2025 among 84 nurse-midwives: 43:41 to the intervention and control groups. Participants were among the 90 second-year diploma nursing and midwifery students from a quasi-experimental reference study conducted between March and June 2023, with 45 students in the intervention group and 45 in the control group. Both study groups received lectures, while the intervention group received additional simulation-based education on initial neonatal care. Data were collected using a structured, electronic questionnaire—the same questionnaire employed in the reference study. Data were analyzed using descriptive statistics, paired t-test, McNemar’s exact test, and Generalized Linear Mixed Models. Results: After two years of simulation-based education on initial neonatal care, knowledge declined in both groups but remained higher in the intervention group (16.3 vs. 12.7), with higher knowledge retention (7.2 vs. 4.2 points). The adjusted difference-in-differences analysis showed no significant long-term effect of simulation on knowledge retention (aDiD = 0.06; 95% CI: −1.47 to 1.60; p = 0.935). Conclusions: The intervention group had higher observed knowledge scores at follow-up, but the study did not demonstrate a statistically significant differential long-term effect of the single SBE intervention. Implication: Integrating simulation-based education into nursing curriculum and professional training may enhance knowledge retention.