Improving essential obstetric and newborn care in resource-poor countries

Abstract

Skilled birth attendance (SBA) and essential obstetric care (EOC) are key strategies for reducing maternal and newborn mortality and morbidity globally. Lack of adequately trained competent staff is a key barrier to achieving this. We assessed the effectiveness of a new package of 'Life Saving Skills - Essential Obstetric and Newborn Care Training' (LSS-EOC and NC) designed specifically around the UN signal functions in seven countries in sub-Saharan Africa. Among 600 healthcare providers (nurse-midwives, doctors, clinical officers and specialists), knowledge about the diagnosis and management of complications of pregnancy and childbirth as well as newborn care significantly increased (p < 0.001). There was measurable improvement in skills (p < 0.001), and participants expressed a high level of satisfaction with the training. The training package was found to meet the needs of healthcare providers, increased awareness of the need for evidence-based care and encouraged teamwork.

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

“…The educational intervention was a combination of 1-week lecture courses, emergency simulations, one-to-one clinical on-the-job training and leadership training. This was considerably more substantial than other existing, emergency obstetric, 3-day courses 23. We suggest that this multifaceted educational approach to change clinical practice is a powerful and novel way of reducing the burden of maternal and neonatal mortality in sub-Saharan Africa.…”

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

“…Robust tests and questionnaires were presented, with qualitative and quantitative analysis that showed the positive benefits of training using the Kirkpatrick levels of reaction and learning, but the study did not assess changes in provider behaviour. 30,31 In a study of task-shifting surgical skills for comprehensive emergency obstetric care, from specialist obstetricians to district medical officers or clinical officers in Burkina Faso, there is evidence that a 6-month surgical training programme for medical officers or a 2-year programme for nurses/clinical officers is effective in reducing operating time and hospital stay, with the added benefit of lower costs. Perioperative complications were similar, including case-fatality rates for mothers.…”

“…Task-shifting training to non-physician obstetricians and anaesthetists allows for the scaling up of comprehensive obstetric care in remote areas EONC skills training was well received by participants and resulted in a measurable increase in knowledge. It was not possible to measure behavioural change in the clinical environment 30 GPs and trained clinical officers provide effective operative delivery care at significantly lower cost than obstetricians; however, the case fatality for newborns was highest in the lowest clinical cadre 32 Trained rural non-physician teams can increase the Caesarean section rates by 300%, with an associated 60% decrease in the stillbirth rate 15,33 Theme: EONC environmental enablers and barriers in access and referral to professional care (second delay) Access was reviewed in a maternal death case series. The contributory factors included delayed, prolonged transportation and sequential facility transfer as a result of facility supply and cover issues 45 The failure to acknowledge and recognise the emergent nature of obstetric complications is observed not only at family level but also at community and facility level: there is an absence of the appropriate level of urgency.…”

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

“…Thirteen studies had been conducted in [19][20][21][22][23][24][25][26][27][28] 6 DH (L2&L3) -HIC 10 RCT 2a,b,c 3b NHS Foundation Trust, Liverpool, UK [44,45] --HIC 1 Before-after 4b,c Victoria, Australia [46] 7 [48] --LMIC 1 Before-after 1 2b −−− −−− Sub-Saharan Africa (7 countries) [49] --LMIC 1 Before-after 1 2b,c −−− −−− Somaliland, Somalia [50] 3 8 LMIC 1 Before-after 1 2b,c 3a 4b Making it Happen, Bangladesh & India [52] 4 DH (Bangl.) [54] 3 DH; 3 FH 40 LMIC 1 Quasi-experimental 3c CRM based National study, US [58] 15 -HIC 1 RCT 4c Beth Israel Deaconness Medical Center, US [59] 1 TTH -HIC 1 Before-after 2a 4b,c Perinatal Safety Initiative, US [60] 1 TH -HIC 1 Before-after 3a 4b,c Rhode Island Hospital, US [61] 1 -HIC 1 Before-after 4b,c Geneva University Hospital, Switzerland [63] 1 TTH -HIC 1 Before-after 1 2a 3a TeamSTEPPS, US [18] 3 CH -HIC 1 RCT 2a 4c OBCTT, Southeast US [62] 1 TTH -HIC 1 Quasi-experimental before-after 1 2a,b,c −−− −−− OTHER CEmONC, Tanzania [17] 1 DH LMIC 1 Before-after 3c Copenhagen University Hospital, Denmark [64] 1 TTH -HIC 1 Before-after 1 2a,b 3a 4b University of Oporto, Portugal [65] 1 TTH -HIC 1 Before-after 1 2b 3a * In progress -abstracts not included [31,32] DH = district hospital L1 = level 1 −−− = studies not going beyond Kirkpatrick level 2 RH = referral hospital L2 = level 2 (secondary/regional) FH = field hospital TH = tertiary hospital/medical centre L3 = level 3 (tertiary) CH = community hospital TTH = tertiary and teaching hospital included in the studies spans the whole spectrum from tertiary teaching hospitals to community-and field hospitals.…”