A systematic review of essential obstetric and newborn care capacity building in rural sub‐<scp>S</scp>aharan <scp>A</scp>frica

This paper reviews evidence regarding change in healthcare-provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed -5 randomised controlled trials, 2 quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in highincome countries and adapted for use in low-and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all healthcare providers. The challenges are: scaling up such training to all institutions; sustaining regular in-service training; integrating training into institutional and health-system patient-safety initiatives; and 'thinking-out-of-the-box' in evaluation research.

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“…Ni Bhuinneain and McCarthy refer to a possible short-term Hawthorne effect with unsustainable outcomes on a larger scale [70].…”

Section: Future Agendamentioning

confidence: 99%

What is the impact of multi-professional emergency obstetric and neonatal care training?

Bergh

Baloyi

Pattinson

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…Community resources that sensitize and empower access to maternal health services also result in a rise in health facility childbirth and skilled birth attendance in rural SSA [10]. However, availability, accessibility, and affordability as well as the nature of public health care services and demand factors appear to contribute to the larger urban-rural inequalities on maternal health care [11].…”

Section: Introductionmentioning

confidence: 99%

Birth preparedness, complication readiness and associated factors among pregnant women in Agnuak zone, Southwest Ethiopia: a community based comparative cross-sectional study

Letose

Admassu

Tura

2020

BMC Pregnancy Childbirth

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Background: Birth Preparedness and Complication Readiness interventions have a significant role in the reduction of maternal and neonatal mortality risk. Inadequacy of birth and emergency preparedness were depicted as one of the major reasons for high maternal deaths in sub-Saharan Africa. The main objective of this study was to assess birth preparedness, complication readiness and associated factors among pregnant women. Methods: A community based comparative cross-sectional study design was conducted among 411 urban and 209 rural respondents who were selected using multi-stage stratified random sampling technique. Quantitative data were collected by interviewer administered questionnaire while qualitative data were collected from purposely selected 54 members of the community by using guiding checklist and analyzed by thematic areas. Birth preparedness and complication readiness was measured using five birth preparedness and complication readiness items then women who scored at least three were considered as well prepared. Bivariate and multivariable logistic regressions were used to examine the association between independent variables and birth preparedness and complication readiness. The result were presented as Odds Ratio at 95% CI. P < 0.05 ware used to dictate statistical significance. Results: A total response rate of the study was 97.3%. The prevalence of birth preparedness and complication readiness was significantly higher among urban respondents (P = 25.8%; p < 0.05). Factors such as history of obstetric complication, knowledge of key danger signs, having favourable attitude towards birth preparedness and complication readiness, starting antenatal care visit within 3 months age of pregnancy, completing at least four antenatal care visits, urban residence, having occupation of government employee or merchant and being in the higher wealth quintile were variables positively associated with birth preparedness and complication readiness. Conclusions: Prevalence of birth preparedness and complication readiness was low in this study, though significantly higher in urban area. Three-fourth of women planned to attend 4+ antenatal care visits indicating opportunity to counsel them on birth preparedness and complication readiness which increases its prevalence. Health workers should counsel every woman on birth preparedness and complication readiness components during her first antenatal care visit and subsequent visits.

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“…Emergency obstetric care (EmOC) provided by a skilled birth attendant in a timely fashion can significantly reduce pregnancy-related morbidity and mortality 5. Previous estimates suggest that when EmOC is performed by a competent healthcare provider, intrapartum stillbirths may be reduced by between 45% and 75%,6 and institutional maternal mortality may be reduced by between 15% and 50% 7…”

Section: Introductionmentioning

confidence: 99%

Social return on investment of emergency obstetric care training in Kenya

Banke-Thomas¹,

Madaj

Broek

2019

BMJ Glob Health

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IntroductionEmergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology.MethodsMixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions.ResultsTrained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred.ConclusionEmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.

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A systematic review of essential obstetric and newborn care capacity building in rural sub‐Saharan Africa

Cited by 30 publications

References 54 publications

What is the impact of multi-professional emergency obstetric and neonatal care training?

What is the impact of multi-professional emergency obstetric and neonatal care training?

Birth preparedness, complication readiness and associated factors among pregnant women in Agnuak zone, Southwest Ethiopia: a community based comparative cross-sectional study

Social return on investment of emergency obstetric care training in Kenya

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