An integrated approach to improve maternal and perinatal outcomes in rural Guatemala: A stepped‐wedge cluster randomized trial

Abstract

Objective To evaluate the impact of an intervention package on maternal and newborn health indicators. Methods A randomized stepped‐wedge non‐blind trial was conducted across six subdistricts within two districts in Guatemala from January 2014 to January 2017. Data on outcomes were collected on all deliveries in all 33 health centers. The intervention package included distribution of promotional materials encouraging health center delivery; education for traditional birth attendants about the importance of health center delivery; and provider capacity building using simulation training. Main outcomes were number of health center deliveries, maternal morbidity, and perinatal morbidity and mortality. Results Overall, there were 24 412 deliveries. Health center deliveries per 1000 live births showed an overall increase, although after adjustment for secular trends and clustering, the relative risk for the treatment effect was not statistically significant (aRR, 1.04; 95% confidence interval [CI], 0.97–1.11, P=0.242). Although not statistically significant, maternal morbidity (aRR, 0.78; 95% CI, 0.60–1.02; P=0.068) and perinatal morbidity (aRR, 0.84; 95% CI, 0.68–1.05; P=0.133) showed a tendency toward a decrease. Conclusion The present study represents one of the few randomized evaluations of an integrated approach to improve birth outcomes in a low‐income setting. ClinicalTrials.gov: NCT0315107.

Lack of Experience is a Main Cause of Maternal Death in Placenta Accreta Spectrum Patients

“…The absence of information on mortality associated with PAS in the English-language literature is remarkable. There are a few publications in Japanese 3 and in the LMIC population 19,20 describing details about fatal cases. In this study, failures in the diagnosis process were detected in 64.6% of cases, including the inability to detect PAS by prenatal ultrasound in 63.9% of the cases (Table 2).…”

Effect of a quality improvement intervention for management of preterm births on outcomes of all births in Kenya and Uganda: A secondary analysis from a facility-based cluster randomized trial

“…Unique components of the PTBi intervention like simulation and team training implemented in Mexico demonstrated that it can reduce neonatal mortality [14]. In other studies, from Guatemala and India, PRONTO's simulation and team training increased use of evidence-based practices in normal and complicated deliveries when these activities were integrated along with didactic teaching and demonstrations [15][16][17][18]. Similar packaged interventions are currently being implemented in several sub-Saharan countries to examine if individual components can synergistically act with each other to bring about a larger reduction in perinatal mortality [19,20].…”

A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania: Study protocol for the evaluation of the MAMA intervention

“…PRONTO International is a non-governmental organization whose simulation and team-training curriculum has been implemented in a variety of clinical settings, from primary health centers to district and regional hospitals (24)(25)(26)(27). The PRONTO model has been applied and evaluated in multiple settings, including East Africa, and has been shown to improve provider skills (25,27,28), reduce morbidity and mortality(26, [29][30][31], and improve the use of RMC practices (9). The interactive curriculum is based on simulation and debrie ng of clinical scenarios, case-based learning, skills stations, and teamwork activities.…”