Accelerated Training of Skilled Birth Attendants in a Marginalized Population on the Thai-Myanmar Border: A Multiple Methods Program Evaluation

Abstract

BackgroundTo evaluate a skilled birth attendant (SBA) training program in a neglected population on the Thai-Myanmar border, we used multiple methods to show that refugee and migrant health workers can be given effective training in their own environment to become SBAs and teachers of SBAs. The loss of SBAs through resettlement to third countries necessitated urgent training of available workers to meet local needs.Methods and FindingsAll results were obtained from student records of theory grades and clinical log books. Qualitative evaluation of both the SBA and teacher programs was obtained using semi-structured interviews with supervisors and teachers. We also reviewed perinatal indicators over an eight-year period, starting prior to the first training program until after the graduation of the fourth cohort of SBAs.ResultsFour SBA training programs scheduled between 2009 and 2015 resulted in 79/88 (90%) of students successfully completing a training program of 250 theory hours and 625 supervised clinical hours. All 79 students were able to: achieve pass grades on theory examination (median 80%, range [70–89]); obtain the required clinical experience within twelve months; achieve clinical competence to provide safe care during childbirth. In 2010–2011, five experienced SBAs completed a train-the-trainer (TOT) program and went on to facilitate further training programs. Perinatal indicators within Shoklo Malaria Research Unit (SMRU), such as place of birth, maternal and newborn outcomes, showed no significant differences before and after introduction of training or following graduate deployment in the local maternity units. Confidence, competence and teamwork emerged from qualitative evaluation by senior SBAs working with and supervising students in the clinics.ConclusionsWe demonstrate that in resource-limited settings or in marginalized populations, it is possible to accelerate training of skilled birth attendants to provide safe maternity care. Education needs to be tailored to local needs to ensure evidence-based care of women and their families.

Trends and birth outcomes in adolescent refugees and migrants on the Thailand-Myanmar border, 1986-2016: an observational study

“…When this occurred, it was recorded as an unknown pregnancy outcome. Staff encouraged women to deliver at a staffed and equipped facility although the tradition (or necessity) in the early years was homebirth 23 . Progress of labor was monitored using the WHO partogram, and women requiring cesarean section were referred to the nearest Thai government hospital where this service was available.…”

Strategies for the prevention of perinatal hepatitis B transmission in a marginalized population on the Thailand-Myanmar border: a cost-effectiveness analysis

“…The migrant sites, Wang Pha and Mawker Thai established birthing facilities in 2007 and 2010 and provide free services predominantly to agricultural migrants from Myanmar in rural areas 30 km north and 60 km south of Mae Sot, Tak Province, Thailand. Births in SMRU units are described in more detail in White et al 2016 [ 33 ].…”

An overview of advances in global maternal health: From broad to specific improvements

“…Since the Jamkhed project, countries such as Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe have had an increased presence of skilled birth attendants in addition to a good referral system, and these have led to reductions in maternal mortality . A more recent and promising example of the successful training of skilled birth attendants is along the Thai‐Myanmar border . The rapid training and qualification of hundreds of skilled birth attendants in this conflict zone, by providing education to fulfill local health demands, yields hope for delivery of successful trainings across other challenging settings worldwide …”

“…15 A more recent and promising example of the successful training of skilled birth attendants is along the Thai-Myanmar border. 16 The rapid training and qualification of hundreds of skilled birth attendants in this conflict zone, by providing education to fulfill local health demands, yields hope for delivery of successful trainings across other challenging settings worldwide. 16 Overall, a significant advance in the field of maternal health is the increased presence of skilled birth attendants worldwide, from 61% in 2000 to 78% in 2016.…”

“…16 The rapid training and qualification of hundreds of skilled birth attendants in this conflict zone, by providing education to fulfill local health demands, yields hope for delivery of successful trainings across other challenging settings worldwide. 16 Overall, a significant advance in the field of maternal health is the increased presence of skilled birth attendants worldwide, from 61% in 2000 to 78% in 2016. 17 Importantly, such increased presence has contributed to a decrease in worldwide maternal mortality, between 1990 and 2015, according to WHO.…”