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Mbwele B, Twaha A, Maksym K, Caputo M, Mkenda DD, Halpern H, Berney S, Kaminyoge EA, Kaminyoge MS, Kaler M, Sobhy S, Hillman SL. The impact of a blended multidisciplinary training for the management of obstetric haemorrhage in Mbeya, Tanzania. Front Glob Womens Health 2023; 4:1270261. [PMID: 38145250 PMCID: PMC10748492 DOI: 10.3389/fgwh.2023.1270261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023] Open
Abstract
Background The Maternal Mortality Rate (MMR) in Tanzania is 78 times higher than that of the UK. Obstetric haemorrhage accounts for two-thirds of these deaths in Mbeya, Tanzania. A lack of healthcare providers' (HCPs') competencies has been the key attribute. This study measured the impact on HCP's competencies from a blended training programme on obstetric haemorrhage. Methods A "before and after" cohort study was undertaken with HCPs in 4 hospitals in the Mbeya region of Tanzania between August 2021 and April 2022. A multidisciplinary cohort of 34 HCPs (doctors, nurses, midwives, anaesthetists and radiologists) were enrolled on a blended face-to-face and virtual training course. The training was delivered by a multidisciplinary team (MDT) from London, UK, assisted by local multidisciplinary trainers from Mbeya, Tanzania and covered anaesthetic, obstetrics, haematology and sonographic use. Results There were 33 HCP in the cohort of trainees where 30/33 (90.9%) of HCPs improved their Anaesthesia skills with a mean score improvement of 26% i.e., 0.26 (-0.009 -0.50), 23 HCPs (69.7%) improved obstetric skills 18% i.e., 0.18 (-0.16 to 0.50), 19 (57.6%), (57.6%) improved competences in Haematology 15%.i.e., 0.15 (-0.33 to 0.87), 20 out of 29 HCPs with ultrasound access (68.8%) improved Sonographic skills 13%.i.e., 0.13 (-0.31 to 0.54). All 33 HCPs (100%) presented a combined change with the mean score improvement of difference of 25% i.e., 0.25 (0.05-0.66). The deaths attributed to obstetric haemorrhage, the mortality rate declined from 76/100,000 to 21/100,000 live births. Actual number of deaths due to obstetric haemorrhage declined from 8 before training to 3 after the completion of the training. Conclusion This comprehensive blended training on anaesthetic surgical, haematological, and sonographic management of obstetric haemorrhage delivers a significant positive impact on the detection, management and outcomes of obstetric haemorrhage.
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Affiliation(s)
- Bernard Mbwele
- Department of Epidemiology and Bio-Statistics, University of Dar es Salaam—Mbeya College of Health and Allied Sciences, UDSM-MCHAS, Mbeya, Tanzania
- Programme Development, Vijiji Tanzania, Mbeya, Tanzania
| | - Amani Twaha
- Obstetrics Department, Mbeya Zonal Referral Hospital (MZRH), Mbeya, Tanzania
| | - Kasia Maksym
- Medical School Building, UCL EGA Institute for Women’s Health, London, United Kingdom
| | - Matthew Caputo
- Department of Statistics, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Delfina D. Mkenda
- Obstetrics Department, Mbeya Zonal Referral Hospital (MZRH), Mbeya, Tanzania
| | - Helen Halpern
- Programme Development, Tanzania UK Healthcare Diaspora Association, London, United Kingdom
| | - Sylvia Berney
- Programme Development, Tanzania UK Healthcare Diaspora Association, London, United Kingdom
| | - Elias A. Kaminyoge
- Obstetrics Department, Mbeya Zonal Referral Hospital (MZRH), Mbeya, Tanzania
| | | | - Mandeep Kaler
- Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Soha Sobhy
- Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sara L. Hillman
- Medical School Building, UCL EGA Institute for Women’s Health, London, United Kingdom
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van Tetering AAC, Ntuyo P, Martens RPJ, Winter N, Byamugisha J, Oei SG, Fransen AF, van der Hout-van der Jagt MB. Simulation-Based Training in Emergency Obstetric Care in Sub-Saharan and Central Africa: A Scoping Review. Ann Glob Health 2023; 89:62. [PMID: 37780839 PMCID: PMC10540704 DOI: 10.5334/aogh.3891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Every day approximately 810 women die from complications related to pregnancy and childbirth worldwide. Around two thirds of these deaths happen in sub-Saharan Africa. One of the strategies to decrease these numbers is improving the quality of care by emergency obstetric simulation-based training. The effectiveness of such training programs depends on the program's instructional design. Objective This review gives an overview of studies about emergency obstetric simulation-based training and examines the applied instructional design of the training programs in sub-Saharan and Central Africa. Methods We searched Medline, Embase and Cochrane Library from inception to May 2021. Peer-reviewed articles on emergency obstetric, postgraduate, simulation-based training in sub-Saharan and Central Africa were included. Outcome measures were categorized based on Kirkpatrick's levels of training evaluation. The instructional design was evaluated by using the ID-SIM questionnaire. Findings In total, 47 studies met the inclusion criteria. Evaluation on Kirkpatrick level 1 showed positive reactions in 18 studies. Challenges and recommendations were considered. Results on knowledge, skills, and predictors for these results (Kirkpatrick level 2) were described in 29 studies. Retention as well as decay of knowledge and skills over time were presented. Results at Kirkpatrick level 3 were measured in 12 studies of which seven studies demonstrated improvements of skills on-the-job. Improvements of maternal and neonatal outcomes were described in fifteen studies and three studies reported on cost-estimations for training rollout (Kirkpatrick level 4). Instructional design items were heterogeneously applied and described. Conclusions Results of 47 studies indicate evidence that simulation-based training in sub-Saharan and Central Africa can have a positive impact across all four levels of Kirkpatrick's training evaluation model. However, results were not consistent across all studies and the effects vary over time. A detailed description of instructional design features in future publications on simulation-based training will contribute to a deeper understanding of the underlying mechanisms that determine why certain training programs are more effective in improving maternal and neonatal healthcare outcomes than other.
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Affiliation(s)
- Anne A. C. van Tetering
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, NL
| | - Peter Ntuyo
- Department of Obstetrics and Gynaecology, Mulago Specialised Women and Neonatal Hospital, UG
| | | | - Naomi Winter
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Utrecht, NL
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, UG
| | - S. Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, NL
| | | | - M. Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, NL
- Department of Biomedical Engineering Eindhoven University of Technology, Eindhoven, NL
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Bahr MH, Abdelaal Ahmed Mahmoud M Alkhatip A, Ahmed AG, Elgamel AF, Abdelkader M, Hussein HA. Hemodynamic Effects of Oxytocin and Carbetocin During Elective Cesarean Section in Preeclamptic Patients Under Spinal Anesthesia: A Randomized Double-blind Controlled Study. Anesth Pain Med 2023; 13:e128782. [PMID: 37489165 PMCID: PMC10363363 DOI: 10.5812/aapm-128782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 07/26/2023] Open
Abstract
Background Oxytocin and carbetocin are uterotonic medications that are used to decrease postpartum hemorrhage (PPH). However, there are not enough clinical data about the hemodynamic side effects of carbetocin. Objectives This study aimed to compare carbetocin and oxytocin hemodynamic effects in preeclamptic patients undergoing elective cesarean section under spinal anesthesia. Methods In this double-blind, randomized controlled trial, intravenous oxytocin or carbetocin was administered to 80 women (40 per group). The hemodynamic effects, such as blood pressure (BP), heart rate (HR), and oxygen (O2) saturation, were measured before the operation and after 1, 5, 10, and 15 minutes of the administration of both drugs. Intragroup and intergroup comparisons were conducted during statistical analysis. Results Based on the intragroup comparison, there was a significant increase in HR and a reduction in BP from baseline to all intervals after the administration of both interventions. Moreover, based on the intergroup comparison, there was a significantly more increase in HR and a decline in BP and O2 saturation in the oxytocin group than in the carbetocin group. There were three and seven cases that required another dose of carbetocin and oxytocin, respectively. Moreover, one case developed PPH in the carbetocin group; nevertheless, two cases developed PPH in the oxytocin group. Conclusions The minimal effect of carbetocin on patients' hemodynamics suggests extending the use of this drug instead of oxytocin as a uterotonic drug in patients with preeclampsia, hemorrhagic risk factors, and/or hypertension.
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Affiliation(s)
- Mahmoud Hussein Bahr
- Department of Anaesthesiology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
- Beni Suef University Hospital, Beni Suef University, Beni Suef, Egypt
| | - Ahmed Abdelaal Ahmed Mahmoud M Alkhatip
- Department of Anaesthesiology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
- Beni Suef University Hospital, Beni Suef University, Beni Suef, Egypt
| | - Ahmed Goda Ahmed
- Department of Anaesthesiology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
- Beni Suef University Hospital, Beni Suef University, Beni Suef, Egypt
| | - Amira Fouad Elgamel
- Beni Suef University Hospital, Beni Suef University, Beni Suef, Egypt
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Mohamed Abdelkader
- Department of Anaesthesiology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
- Beni Suef University Hospital, Beni Suef University, Beni Suef, Egypt
| | - Hazem Abdelwaheb Hussein
- Department of Anaesthesiology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
- Beni Suef University Hospital, Beni Suef University, Beni Suef, Egypt
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Welsh J, Hounkpatin H, Gross MM, Hanson C, Moller AB. Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000-2020. BMC MEDICAL EDUCATION 2022; 22:725. [PMID: 36242024 PMCID: PMC9568981 DOI: 10.1186/s12909-022-03772-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Levels of maternal and neonatal mortality remain high in sub-Saharan Africa, with an estimated 66% of global maternal deaths occurring in this region. Many deaths are linked to poor quality of care, which in turn has been linked to gaps in pre-service training programmes for midwifery care providers. In-service training packages have been developed and implemented across sub-Saharan Africa in an attempt to overcome the shortfalls in pre-service training. This scoping review has aimed to summarize in-service training materials used in sub-Saharan Africa for midwifery care providers between 2000 and 2020 and mapped their content to the International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice. METHODS Searches were conducted for the years 2000-2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Science Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a search of grey literature from international organizations was also performed. Identified in-service training materials that were accessible freely on-line were mapped to the ICM Essential Competencies for midwifery practice. RESULTS The database searches identified 1884 articles after removing duplicates. After applying exclusion criteria, 87 articles were identified for data extraction. During data extraction, a further 66 articles were excluded, leaving 21 articles to be included in the review. From these 21 articles, six different training materials were identified. The grey literature yielded 35 training materials, bringing the total number of in-service training materials that were reviewed to 41. Identified in-service training materials mainly focused on emergency obstetric care in a limited number of sub-Saharan Africa countries. Results also indicate that a significant number of in-service training materials are not readily and/or freely accessible. However, the content of in-service training materials largely met the ICM Essential Competencies, with gaps noted in the aspect of woman-centred care and shared decision making. CONCLUSION To reduce maternal and newborn morbidity and mortality midwifery care providers should have access to evidence-based in-service training materials that include antenatal care and routine intrapartum care, and places women at the centre of their care as shared decision makers.
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Affiliation(s)
- Joanne Welsh
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Claudia Hanson
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
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Okonofua FE, Ekezue B, Ntoimo LFC, Ekwo C, Ohenhen V, Agholor K, Igboin B, Imongan W, Galadanci H, Ogu R. Effects of multifaceted interventions to prevent and manage primary postpartum haemorrhage in referral hospitals: a quasi-experimental study in Nigeria. BMJ Glob Health 2022; 7:bmjgh-2021-007779. [PMID: 35443937 PMCID: PMC9021787 DOI: 10.1136/bmjgh-2021-007779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Primary postpartum haemorrhage (PPH) is the leading cause of Nigeria's high maternal mortality rate. This study investigated the effectiveness of a set of multifaceted interventions to manage and reduce PPH in selected secondary referral health facilities in Nigeria. METHODS This is a quasi-experimental study using an interrupted time-series design to assess a set of multifaceted interventions that address factors identified by stakeholders as associated with PPH. Interventions were implemented at two regional general hospitals, with a general hospital in the same region as the control. Intervention participants were women during antepartum and clinical and administrative staff. Cases of PPH were determined in women at delivery. The outcomes measured were the incidence of primary PPH and related deaths during the study period. Analyses included a comparative description of characteristics of the women, trend of time-series data at intervention and control hospitals, and multivariable analysis of factors associated with PPH occurrence. RESULTS Monthly numbers of primary PPH were collected at participating hospitals over 21 months for 18 181 women. Intervention hospitals represent 54% vs 46% in control hospitals. Time-series analyses show a significant downward trend in intervention hospitals. The overall incidence of primary PPH was lower in the intervention hospitals than in the control hospitals. Multilevel regression adjusted for hospital-level effect showed a 68% reduction in odds of PPH cases at intervention compared with control hospitals. There were 12 PPH-related maternal deaths in one of the control hospitals, with no deaths in the intervention hospitals. CONCLUSION We conclude that multiple interventions that address identified challenges in the prevention of primary PPH can potentially effectively reduce reported primary PPH in Nigerian referral hospitals. This approach is relevant for scaling the development of policies and programmes to prevent primary PPH and maternal mortality in Nigeria.
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Affiliation(s)
- Friday Ebhodaghe Okonofua
- Women's Health and Action Research Centre, Benin City, Nigeria .,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Bola Ekezue
- Fayetteville State University, Fayetteville, North Carolina, USA
| | - Lorretta Favour Chizomam Ntoimo
- Women's Health and Action Research Centre, Benin City, Nigeria.,Department of Demography and Social Statistics, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - C Ekwo
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - V Ohenhen
- Central Hospital, Benin City, Nigeria
| | | | - Brian Igboin
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - H Galadanci
- Faculty of Medicine, Bayero University, Kano, Nigeria
| | - R Ogu
- College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria
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