Up-skilling associate clinicians in Malawi in emergency obstetric, neonatal care and clinical leadership: the ETATMBA cluster randomised controlled trial

Ellard, David R; Chimwaza, Wanangwa; Davies, David; Simkiss, Douglas E.; Kamwendo, Francis; Mhango, Chisale; Quenby, Siobhán; Kandala, Ngianga‐Bakwin; O’Hare, J. Paul

doi:10.1136/bmjgh-2015-000020

Cited by 7 publications

(3 citation statements)

References 25 publications

(28 reference statements)

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“…A previous Malawian study has shown that training and task-shifting efforts seem to have had a positive effect on maternal mortality [40]. Furthermore, experiences with task-shifting in other developing countries such as India and Sierra Leone yielded comparable results when surgery was performed by less educated health personnel [34–36].…”

Section: Discussionmentioning

confidence: 99%

“Confidence comes with frequent practice”: health professionals’ perceptions of using manual vacuum aspiration after a training program

et al. 2019

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Background Malawi has one of the highest maternal mortality rates in the world, with unsafe abortion as a major contributor. Curettage is most frequently used as the surgical method for treating incomplete abortions, even though it is costly for an impoverished health system and the less expensive and safe manual vacuum aspiration (MVA) method is recommended. Methods The aim of this 2016–17 study is to explore health worker’s perception of doing MVA 1 year after an educational intervention. Focus group discussions were recorded, transcribed verbatim, and analyzed using content analysis for interpreting the findings. A knowledge, attitude and practice survey was administered to health professionals to obtain background information before the MVA training program was introduced. Results Prior to the training sessions, the participants demonstrated knowledge on abortion practices and had positive attitudes about participating in the service, but preferred curettage over MVA. The training was well received, and participants felt more confident in doing MVA after the intervention. However, focus group discussions revealed obstacles to perform MVA such as broken equipment and lack of support. Additionally, the training could have been more comprehensive. Still, the participants appreciated task-sharing and team work. Conclusion Training sessions are considered useful in increasing the use of MVA. This study provides important insight on how to proceed in improving post-abortion care in a country where complications of unsafe abortion are common and the health system is low on resources.

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Section: Discussionmentioning

confidence: 99%

“Confidence comes with frequent practice”: health professionals’ perceptions of using manual vacuum aspiration after a training program

et al. 2019

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“…In Malawi, Ellard et al 13 conducted a cluster randomized control trial of a 3-year training package focused on improving skills and knowledge related to emergency obstetric and newborn care. Their study revealed that neonatal mortality reduced by 31% as a result of training.…”

Section: Discussionmentioning

confidence: 99%

The Impact of an Educational Intervention on Neonatal Care and Survival

Emmanuel

Kain

Forster

2023

Journal of Perinatal &Amp; Neonatal Nursing

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Objective: Under-5 mortality has declined globally; however, proportion of under-5 deaths occurring within the first 28 days after birth has increased significantly. This study aims to determine the impact of an educational intervention on neonatal care and survival rates in Nigeria. Methods: This was a sequential exploratory mixed-methods design involving 21 health workers in the preintervention phase, while 15 health workers and 30 mother-baby dyads participated in the postintervention phase. Data were collected using semistructured interviews and nonparticipatory observation. Qualitative data were analyzed using thematic analysis, while quantitative data were analyzed using descriptive and inferential statistics. Results: Healthy newborns were routinely separated from their mothers in the preintervention period. During this time, non-evidence-based practices, such as routine nasal and oral suctioning, were performed. Skin-to-skin contact and early initiation of breastfeeding were frequently interrupted. After the intervention, 80.6% were placed in skin-to-skin contact with their mothers, and 20 of these babies maintained contact with the mother until breastfeeding was established. There was decline in neonatal deaths post-intervention. Independent t-test analysis of the day of neonatal death demonstrates a significant difference in mean (P = .00, 95% confidence interval −5.629; −7.447 to −4.779). Conclusion: Newborn survival can be improved through regular training of maternity health workers in evidence-based newborn care.

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“…In addition to widespread low levels of utilisation, earlier surveys report significant regions where AVB was not used at all-in 2006 this was the case in 74% of Latin American and Caribbean countries, as well as 30% of countries in sub-Saharan Africa and 40% of countries in Asia [4]. In addition to a lack of trained accouchers in LMICs [5][6][7], the maintenance and sterilisation requirements of both forceps and ventouse may limit their utilisation [4]. There is a significant unmet need for AVB in all maternity settings, but particularly in LMICs.…”

Section: Introductionmentioning

confidence: 99%

The ASSIST Study - The BD Odon Device for assisted vaginal birth: a safety and feasibility study

O’Brien

Hotton

Lenguerrand

et al. 2018

Preprint

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Background: Assisted vaginal birth is a vital health intervention that can result in better outcomes for mothers and their babies when complications arise in the second stage of labour. Unfortunately, instruments for assisted vaginal birth (forceps and ventouse) are often not utilised in settings where there is most clinical need, resulting in maternal and neonatal morbidity and mortality which could have been prevented. The BD Odon Device is a new device for assisted vaginal birth which may be able to address this unmet need. However, before dissemination the device requires evaluation in robust clinical trials. A feasibility study to investigate the clinical impact, safety and acceptability of the BD Odon Device for assisted vaginal birth is therefore planned. This will provide further information on acceptability, recruitment and the outcome data required to design a future randomised controlled trial of the BD Odon Device versus Kiwi ventouse. Methods: Forty women who require an assisted vaginal birth for a recognised clinical indication will have the birth assisted with the BD Odon Device. The primary outcome is successful vaginal birth completed with the BD Odon Device. Secondary clinical outcomes include maternal and neonatal outcomes, and maternal and practitioner satisfaction. Safety data will be reviewed following every birth. Discussion: A future randomised controlled trial (RCT) of the BD Odon Device versus current standard instrument (the Kiwi ventouse) is planned. The findings of the ASSIST Study will inform the RCT design. Trial registration: ISRCTN registration: ISRCTN10203171 (prospectively registered 27/07/2018). Keywords: BD Odon Device, forceps, ventouse, assisted birth, birth, intrapartum research

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Up-skilling associate clinicians in Malawi in emergency obstetric, neonatal care and clinical leadership: the ETATMBA cluster randomised controlled trial

Cited by 7 publications

References 25 publications

“Confidence comes with frequent practice”: health professionals’ perceptions of using manual vacuum aspiration after a training program

“Confidence comes with frequent practice”: health professionals’ perceptions of using manual vacuum aspiration after a training program

The Impact of an Educational Intervention on Neonatal Care and Survival

The ASSIST Study - The BD Odon Device for assisted vaginal birth: a safety and feasibility study

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