Can training in advanced clinical skills in obstetrics, neonatal care and leadership, of non-physician clinicians in Malawi impact on clinical services improvements (the ETATMBA project): a process evaluation

Ellard, David R; Chimwaza, Wanangwa; Davies, David; O’Hare, J. Paul; Kamwendo, Francis; Quenby, Siobhán; Griffiths, Frances

doi:10.1136/bmjopen-2014-005751

Cited by 19 publications

(41 citation statements)

References 24 publications

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“…Postpartum hemorrhage is the leading cause of maternal death in Rwanda [27] and world-wide. [28] These study findings concur with the results of previous research on similar CPD education programs which reported increased knowledge, skills, and confidence among participants in obstetric emergency management. [28,29] The midwives perceived that maternal deaths decreased after having participated in an ALSO R course.…”

Section: Discussionsupporting

confidence: 82%

“…[28] These study findings concur with the results of previous research on similar CPD education programs which reported increased knowledge, skills, and confidence among participants in obstetric emergency management. [28,29] The midwives perceived that maternal deaths decreased after having participated in an ALSO R course. Participants' perceptions of the reduction of maternal deaths might be attributed to their improved ability to prevent and manage PPH, avoidance of performing unnecessary episiotomies, and improved inter-professional team work.…”

Section: Discussionsupporting

confidence: 82%

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Midwives’ experience of participating in the Advanced Life Support in Obstetrics® educational program in Rwanda

Uwajeneza

Babenko-Mould

Evans

et al. 2015

JNEP

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High maternal and newborn mortality rates remain a global health issue. Ninety-nine percent of maternal deaths occur in low and middle income countries and many could be prevented by having more qualified health providers. In 2013, 62% of maternal deaths took place in Sub-Saharan Africa. The Advanced Life Support in Obstetrics (ALSO R ) Educational Program is an internationally recognized continuous professional development course aimed at increasing the knowledge, skills, competence, and confidence of health professionals to manage obstetric emergencies. The purpose of this qualitative descriptive study was to explore midwives' experiences of translating the knowledge and skills acquired from participating in the ALSO R program into their professional practice in Rwanda. A purposive sample of nine midwives participated in one-to-one interviews directed at understanding their experience of implementing their new knowledge and skills into practice. All interviews were audio-recorded and transcribed verbatim. Content analysis was used to illuminate five themes: 1) Improved midwifery practice, 2) Availability of resources, 3) Inter-professional collaboration, 4) Job (dis)satisfaction, and 5) Autonomy for midwifery practice. The findings revealed that although midwives reported increased knowledge, skills and confidence in management of obstetric emergencies, their ability to change practice was often hampered by non-conducive work environments, a shortage of health care providers, and insufficient equipment and materials. These findings can serve to inform ALSO R course module development, midwifery education development, and health human resources policy that can address obstetrical and newborn education needs and health service delivery in Rwanda.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 82%

Midwives’ experience of participating in the Advanced Life Support in Obstetrics® educational program in Rwanda

Uwajeneza

Babenko-Mould

Evans

et al. 2015

JNEP

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“…Our items are based on established frameworks 128,129 and our experience of implementing these frameworks. [130][131][132][133] In addition, we include outcome data in this process evaluation, as these are not being analysed elsewhere.…”

Section: Process Evaluationmentioning

confidence: 99%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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BackgroundThe National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care.ObjectivesTo explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective.DesignThe trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation.SettingFive NHS acute trusts in England.ParticipantsParticipants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with ‘best usual care’ (BUC) or BUC alone.InterventionsAll participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session.Main outcome measuresProcess and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months.ResultsFifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84.LimitationsPoor recruitment was a limiting factor.ConclusionsThis feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain.Future workFurther work is needed to test recruitment from alternative clinical situations.Trial registrationEudraCT 2014-000682-50 and Current Controlled Trials ISRCTN93184143.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 30. See the NIHR Journals Library website for further project information.

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“…Use of external mentors from regional referral hospitals that are located closer to the districts may have been a better approach [24]. The Ethiopian study faced similar issues spending on transport for field-based teams for ART mentoring [12]. …”

Section: Discussionmentioning

confidence: 99%

“…Their years of service ranged from three to 35, with an average of 13 years. Lastly, two-thirds [12] of these were female.…”

Section: Methodsmentioning

confidence: 99%

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Ajeani

Ayiasi

Tetui

et al. 2017

Global Health Action

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Background: There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. Objectives: This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model. Methods: The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors. Results: Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better. Conclusions: The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved capacity among local mentors to provide mentorship among local district staff.

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Can training in advanced clinical skills in obstetrics, neonatal care and leadership, of non-physician clinicians in Malawi impact on clinical services improvements (the ETATMBA project): a process evaluation

Cited by 19 publications

References 24 publications

Midwives’ experience of participating in the Advanced Life Support in Obstetrics® educational program in Rwanda

Midwives’ experience of participating in the Advanced Life Support in Obstetrics® educational program in Rwanda

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

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