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Mramel M, El Alaoui M, El Janati Idrissi R. Barriers to clinical learning skills development among midwifery students and newly qualified midwives in Morocco: A qualitative study. BELITUNG NURSING JOURNAL 2024; 10:160-168. [PMID: 38690298 PMCID: PMC11056836 DOI: 10.33546/bnj.3163] [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: 12/11/2023] [Revised: 02/01/2024] [Accepted: 03/17/2024] [Indexed: 05/02/2024] Open
Abstract
Background In Morocco, despite various initiatives to improve the quality of reproductive healthcare, the indicators remain unfavorable. To strengthen the skills of midwives and support the achievement of Millennium Development Goals (MDGs) 4 and 5 by 2030, Morocco has developed and implemented a competency-based training framework. However, there is a lack of information on the successful implementation of this program and its impact on the quality of student midwives' preparation for practice. Objective This study aimed to gain a deeper understanding and explore the barriers affecting the development of clinical learning skills among midwifery students and newly qualified midwives. Methods This study employed a descriptive, exploratory qualitative approach. Data were collected through nine focus group discussions with 30 midwifery students and 24 newly graduated midwives between April and June 2023 from six higher education institutions in northern and central Morocco. Inductive content analysis was used to analyze the transcribed discussions. Results The barriers varied between locations. Overall, the internship design was inadequate, and the clinical environment was insufficient. Participants highlighted limited opportunities to experience the full range of midwifery skills. However, most midwifery students and new graduates had deficient competencies in managing high-risk situations and emergencies. Conclusion This work provides an overview of the nature and extent of the challenges faced by many student midwives in Morocco, resulting in newly graduated midwives being poorly prepared for the full range of midwifery practice. These findings can inform various initiatives to strengthen midwifery education at the global, regional, and national levels.
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Affiliation(s)
- Majida Mramel
- Higher Normal School, Abdelmalek Essâadi University, Tetouan, Morocco
- Higher Institute of Nursing Professions and Health Techniques, Fes, Morocco
| | - Mustafa El Alaoui
- Higher Normal School, Abdelmalek Essâadi University, Tetouan, Morocco
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Uhawenimana TC, Gakwerere M, Ngabonzima A, Yamuragiye A, Harindimana F, Ndayisenga JP. Utilization of technology to provide on-the-job trainings on Emergency Obstetric and Neonatal Care: Perspectives of nurses and midwives working in Rwanda's remote health facilities. PLoS One 2024; 19:e0291219. [PMID: 38669298 PMCID: PMC11051650 DOI: 10.1371/journal.pone.0291219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/25/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION One of the targets for the third sustainable development goals is to reduce worldwide maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030. To address issues affecting women and the newborns during childbirth and postnatal period, concerted efforts from governments and their stakeholders are crucial to maximize the use of technology to enhance frontline health professionals' skills to provide the emergency obstetric and newborn care (EmONC). However, no study has garnered nurses' and midwives' perspectives regarding the application of technology-enhanced learning approach to provide on-the-job Continuous Professional Development (CPD) and factors that may influence the application of this training approach in the Rwandan context. METHODS The study collected data from nurses and midwives from forty (40) public health facilities in remote areas nationwide. The study applied a qualitative descriptive design to explore and describe nurses' and midwives' perspectives on the feasibility and acceptability of technology enhanced learning approaches such as e-learning, phone-based remote training, and other online methods to provide trainings in EmONC. Two focus group discussions with EmONC mentors, two with nurses and midwives were conducted. Twelve key informant interviews were conducted. Participants were selected purposively. In total, 54 individuals were included in this study. A thematic approach was used to analyse data. RESULTS Nurses and midwives highlighted the need to provide refresher trainings about the management of pre-eclampsia. Most of the EmONC trainings are still provided face-to-face and the use of technology enhanced learning approaches have not yet been embraced in delivering EmONC CPDs for nurses and midwives in remote areas. Nurses and midwives found the first developed prototype of smartphone app training of the EmONC acceptable as it met the midwives' expectations in terms of the knowledge and skills' gap in EmONC. CONCLUSION Although the newly developed application was found acceptable, further research involving practical sessions by nurses and midwives using the developed application is needed to garner views about the ease of use of the application, relevance of the EmONC uploaded content on the app, and needed improvements on the app to address their needs in EmONC.
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Affiliation(s)
| | - Mathias Gakwerere
- United Nations Populations Fund East and Southern Africa Region, Johannesburg, South Africa
| | - Anaclet Ngabonzima
- JSI Research and Training Institute Inc, Denver, Colorado, United States of America
| | - Assumpta Yamuragiye
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Jean Pierre Ndayisenga
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Komolafe AO, Olajubu AO, Ijarotimi OA, Ogunlade OB, Olowokere AE, Irinoye OO. Adherence to Practice Guidelines in the Implementation of Emergency Obstetric and Newborn Care in Referral Hospitals in Osun State, Nigeria. SAGE Open Nurs 2024; 10:23779608231226064. [PMID: 38222267 PMCID: PMC10785743 DOI: 10.1177/23779608231226064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction While practice guidelines support clinical decision-making for optimal patient outcomes, there is often nonadherence to practice guidelines in implementing evidence-based interventions. Objectives This article aimed to assess adherence to practice guidelines in emergency obstetric and newborn care (EmONC) and the outcome of pregnancy in cases of obstetric complications in referral hospitals. Method The study employed a descriptive design. A purposive sampling technique was used to select the three tertiary hospitals and six out of nine state hospitals in Osun State. A data extraction form developed based on a fidelity framework was used to collect data on Adherence from 264 cases of obstetric complications. Descriptive statistics, such as frequency and percentage, and inferential statistics, such as chi-square, were done with the significance level set as p < .05. Results Findings showed low adherence to practice guidelines in 70.8% of hemorrhage care, 52.0% of fetal distress care, 60.0% of prolonged obstructed labor care, and 44.4% of preeclampsia/eclampsia care. The study's findings also showed that 64.3% of cases of prolonged/obstructed labor, 54.9% of cases of fetal distress, and 46.7% of all cases of obstetric complications were referred out at the state hospitals. Neonatal mortality in state and tertiary hospitals was 3.7% and 21.7%, respectively, which was significantly different (p < .001). Conclusion There was low adherence to practice guidelines for the implementation of EmONC in state and tertiary hospitals, and a significant number of cases of obstetric complications were referred out in the state hospitals. The low adherence to practice guidelines and numerous referrals truncate the successful implementation of EmONC and hinder women and newborns from receiving optimal care for obstetric complications. There is a need to develop strategies that promote adherence to practice guidelines in implementing EmONC.
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Affiliation(s)
| | | | - Omotade Adebimpe Ijarotimi
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
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Hulsbergen M, Abera B, Adefris M, Kassahun D, Meulenbeld M, van Nievelt S, Ameh C, Bruinooge M, Rijken MJ, Stekelenburg J. Evaluation of the Emergency Obstetric and Newborn Care training in Gondar, Ethiopia; a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000889. [PMID: 37751409 PMCID: PMC10522022 DOI: 10.1371/journal.pgph.0000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/31/2023] [Indexed: 09/28/2023]
Abstract
In Ethiopia maternal and perinatal morbidity and mortality remains high. Timely access to quality emergency obstetric and neonatal care is essential for the prevention of adverse outcomes. Training healthcare providers can play an important role in improving quality of care, thereby reducing maternal and perinatal mortality and morbidity. The aim of this study was to evaluate change of knowledge, skills and behaviour in health workers who attended a postgraduate Emergency Obstetric and Newborn Care training in Gondar, Ethiopia. A descriptive study with before-after approach, using a mix of quantitative and qualitative data, based on Kirkpatrick's model for training evaluation was conducted. The evaluation focussed on reaction, knowledge, skills, and change in behaviour in clinical practice of health care providers and facilitator's perspectives on performance. A 'lessons learned approach' was included to summarize facilitators' perspectives. Health care providers reacted positively to the Emergency Obstetric and Newborn Care training with significant improvement in knowledge and skills. Of the 56 participants who attended the training, 44 (79%) were midwives. The main evaluation score for lectures was 4,51 (SD 0,19) and for breakout sessions was 4,52 (SD 0.18) on scale of 1-5. There was a statistically significant difference in the pre and post knowledge (n = 28, mean difference 13.8%, SD 13.5, t = 6.216, p<0.001) and skills assessments (n = 23, mean difference 27.4%, SD 22.1%, t = 5.941, p<0.001). The results were the same for every component of the skills and knowledge assessment. Overall, they felt more confident in performing skills after being trained. Local sustainability, participant commitment and local context were identified as challenging factors after introducing a new training program. In Gondar Ethiopia, the Emergency Obstetric and Newborn Care training has the potential to increase skilled attendance at birth and improve quality of care, both vital to the reduction of maternal and perinatal mortality and morbidity.
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Affiliation(s)
- Myrrith Hulsbergen
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Center for Evidence Based Education, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Gynaecology Department, Women’s Healthcare Center, Amsterdam, The Netherlands
| | - Birhanu Abera
- Department of Obstetrics and Gynecology, University of Global Health Equity (UGHE), Kigali, Rwanda
| | - Mulat Adefris
- Department of Obstetrics and Gynaecology, University of Gondar, Gondar, Ethiopia
| | - Dawit Kassahun
- Department of Obstetrics and Gynaecology, University of Gondar, Gondar, Ethiopia
| | - Marieke Meulenbeld
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
| | - Sabine van Nievelt
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, Hague, The Netherlands
| | - Charles Ameh
- International Public Health Department Liverpool School of Tropical Medicine, Emergency Obstetric Care and Quality of Care Unit, Liverpool, United Kingdom
| | - Mimosa Bruinooge
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - Marcus J. Rijken
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jelle Stekelenburg
- Working Party on International Safe Motherhood and Reproductive Health, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
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Jejaw M, Debie A, Yazachew L, Teshale G. Comprehensive emergency management of obstetric and newborn care program implementation at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021: an evaluation study. Reprod Health 2023; 20:76. [PMID: 37208688 DOI: 10.1186/s12978-023-01623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Maternal healthcare service is the care given for the woman during her gestation, delivery and postpartum period. The Maternal Mortality Ratio (MMR) was remains high and a public health problem in Ethiopia. Sub-Saharan African (SSA) countries account two-thirds of the global total maternal deaths. To curb such high burden related with child births, comprehensive emergency obstetric care is designed as one of the strategies for maternal healthcare services. However, its implementation status was not well investigated. This study aims to evaluate the implementation of comprehensive emergency obstetric and new born care program in terms of Availability, compliance and acceptability dimensions at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS A single case study design was employed from 01 to 30 April 2021. A total of 265 mothers who gave birth at University of Gondar Comprehensive Specialized Hospital (UoGCSH) during the data collection period for acceptability, 13 key informant interviews (KIIs), 49 non-participatory observations (25 observations during C/S performance and 24 assisted spontaneous vaginal deliver) and 320 retrospective document review were conducted. Availability, compliance and acceptability dimensions were evaluated using 32 indicators. Binary logistic regression model was fitted to identify factors associated with acceptability of the services. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05 were also used to identify associated variables with acceptability. The qualitative data were recorded using tape recorder, transcribed in Amharic and translated to English language. Thematic analysis was done to supplement the quantitative findings. RESULTS The overall implementation of comprehensive emergency obstetric and newborn care (CEmONC) was 81.6%. Moreover, acceptability, availability and care provider's compliance with the guideline accounted 81, 88.9 and 74.8%, respectively. There were stocked-out of some essential drugs, such as methyldopa, nifidipine, gentamycin and vitamin K injection. CEmONC training gaps, inadequate number of autoclaves, shortage of water supply and long-distance delivery ward to laboratory unit were also the barriers for the CEmONC service. Short waiting time of clients (AOR = 2.40; 95%CI: 1.16, 4.90) and maternal educational level (AOR = 5.50, 95%CI: 1.95, 15.60) were positively associated with acceptability of CEmONC services. CONCLUSION The implementation status of CEmONC program was good as per our judgment parameter. Compliance of healthcare providers with the guideline was fair and needed improvement. Essential emergency drugs, equipment and supplies were stocked-out. The University of Gondar Comprehensive Specialized Hospital was therefore had better to give great emphasis to expand maternity rooms/ units. The hospital had better to avail the resources and provide continuous capacity building for healthcare providers to enhance the program implementation.
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Affiliation(s)
| | - Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia
| | - Getachew Teshale
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia.
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Pajohideh ZS, Mohammadi S, Keshmiri F, Jahangirimehr A, Honarmandpour A. The effects of normal vaginal birth simulation training on the clinical skills of midwifery students: a quasi-experiment study. BMC MEDICAL EDUCATION 2023; 23:353. [PMID: 37208680 DOI: 10.1186/s12909-023-04319-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Vaginal birth management is vital to midwifery education and practice in which midwives are most likely to be directly involved. This situation requires strong cognitive, technical, communicational, and teamwork skills. Therefore, the present study was conducted to evaluate the effect of normal vaginal birth simulation training before formal clinical education on the clinical skills of midwifery students compared with routine clinical education. METHODS This quasi-experimental study was conducted at the Shoushtar Faculty of Medical Sciences from September 2018 to August 2021. Sixty-one midwifery students participated in the intervention group (n = 31) and in the control group (n = 30). The intervention group participated in the simulation-based training before entering the formal clinical education courses. The control group received no simulation-based training before their formal clinical education. The clinical skills of these students for performing normal vaginal birth in the real field were evaluated by observational examination in the three years (fourth, fifth, and sixth semesters). Data were analyzed by descriptive (mean, SD, and percentage) and inferential statistics (independent t-test and chi-square). A P-value less than 0.05 was considered significant. RESULTS The mean score of midwives' skills in the control group was (28.10 ± 3.42) and in the intervention group, it was (31.15 ± 4.30). The difference in the skill score between the groups was statistically significant (3.40 ± 0.68). The results showed that in the intervention group, 29 students (93.93%) were evaluated from a good to an excellent level, while only ten students (32.71%) in the control group achieved a good level, and others (n = 30) were evaluated at a low level (p < .001). CONCLUSION The results of the present study indicated that the simulation situation for critical skills, such as vaginal birth skills, was significantly more effective than workplace-based learning situations.
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Affiliation(s)
- Zahra Sadat Pajohideh
- MSc of Midwifery, Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Solmaz Mohammadi
- Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Keshmiri
- Medical Education Department, Educational Developmental Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azam Jahangirimehr
- MSc of Biostatistics, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Azam Honarmandpour
- MSc of Midwifery, Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran.
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Rana MS, Billah SM, Moinuddin M, Bakkar Siddique MA, Khan MMH. Exploring the factors contributing to increase in facility child births in Bangladesh between 2004 and 2017-2018. Heliyon 2023; 9:e15875. [PMID: 37206020 PMCID: PMC10189511 DOI: 10.1016/j.heliyon.2023.e15875] [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: 04/02/2022] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
Background Although Bangladesh has gained rapid improvement in births at health facilities, yet far behind to achieve the SDG target. Assessing the contribution of factors in increased use of delivery at facilities are important to demonstrate. Objective To explore the determinants and their contribution in explaining increased use of facility child births in Bangladesh. Participants Reproductive-aged women (15-49 years) of Bangladesh. Methods and materials We used the latest five rounds (2004, 2007, 2011, 2014, 2017-2018) of Bangladesh Demographic and Health Surveys (BDHSs). The regression based classical decomposition approach has been used to explore the determinants and their contribution in explaining the increased use of facility child birth. Results A sample of 26,686 reproductive-aged women were included in the analysis, 32.90% (8780) from the urban and 67.10% (17,906) from the rural area. We observed a 2.4-fold increase in delivery at facilities from 2004 to 2017-2018, in rural areas it is more than three times higher than the urban areas. The change in mean delivery at facilities is about 1.8 whereas, the predicted change is 1.4. In our full sample model antenatal care visits contribute the largest predicted change of 22.3%, wealth and education contributes 17.3% and 15.3% respectively. For the rural area health indicator (prenatal doctor visit) is the largest drivers contributing 42.7% of the predicted change, hereafter education, demography and wealth. However, in urban area education and health contributed equally 32.0% of the change followed by demography (26.3%) and wealth (9.7%). Demographic variables (maternal BMI, birth order, age at marriage) contributing more than two-thirds (41.2%) of the predicted change in the model without the health variables. All models showed more than 60.0% predictive power. Conclusion Health sector interventions should focus both coverage and quality of maternal health care services to sustain steady improvements in child birth facilities.
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Affiliation(s)
- Md Sohel Rana
- Department of Statistics, Comilla University, Kotbari, 3506, Cumilla, Bangladesh
- Corresponding author.
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
- School of Public Health, The University of Sydney, Australia
| | | | - Md Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
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Bourret K, Mattison C, Hebert E, Kabeya A, Simba S, Crangle M, Darling E, Robinson J. Evidence-informed framework for gender transformative continuing education interventions for midwives and midwifery associations. BMJ Glob Health 2023; 8:bmjgh-2022-011242. [PMID: 36634981 PMCID: PMC9843202 DOI: 10.1136/bmjgh-2022-011242] [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: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Continuing education for midwives is an important investment area to improve the quality of sexual and reproductive health services. Interventions must take into account and provide solutions for the systemic barriers and gender inequities faced by midwives. Our objective was to generate concepts and a theoretical framework of the range of factors and gender transformative considerations for the development of continuing education interventions for midwives. METHODS A critical interpretive synthesis complemented by key informant interviews, focus groups, observations and document review was applied. Three electronic bibliographic databases (CINAHL, EMBASE and MEDLINE) were searched from July 2019 to September 2020 and were again updated in June 2021. A coding structure was created to guide the synthesis across the five sources of evidence. RESULTS A total of 4519 records were retrieved through electronic searches and 103 documents were included in the critical interpretive synthesis. Additional evidence totalled 31 key informant interviews, 5 focus groups (Democratic Republic of Congo and Tanzania), 24 programme documents and field observations in the form of notes. The resulting theoretical framework outlines the key considerations including gender, the role of the midwifery association, political and health systems and external forces along with key enabling elements for the design, implementation and evaluation of gender transformative continuing education interventions. CONCLUSION Investments in gender transformative continuing education for midwives, led by midwifery associations, can lead to the improvement of midwifery across all United Nations' target areas including governance, health workforce, health system arrangements and education.
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Affiliation(s)
- Kirsty Bourret
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden .,McMaster Midwifery Research Center, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cristina Mattison
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emmanuelle Hebert
- Bureau des relations internationales, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Ambrocckha Kabeya
- Société Congolaise de la Pratique Sage-femme, Kinshasa, Democratic Republic of the Congo
| | - Stephano Simba
- Tanzania Midwives Association (TAMA), Dar es Salaam, United Republic of Tanzania
| | - Moya Crangle
- Canadian Association of Midwives, Montreal, Quebec, Canada
| | - Elizabeth Darling
- Obstetrics and Gynecology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jamie Robinson
- Canadian Association of Midwives, Montreal, Quebec, Canada
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Jain Y, Chaudhary T, Joshi CS, Chotiya M, Sinha B, Nair TS, Srivastava A, SV VK, Agrawal A, Srivastava V, Baswal D, Lalchandani K, Shah H, Usmanova G, Sood B, Yadav V, Kumar S. Improving quality of intrapartum and immediate postpartum care in public facilities: experiences and lessons learned from Rajasthan state, India. BMC Pregnancy Childbirth 2022; 22:586. [PMID: 35870874 PMCID: PMC9308226 DOI: 10.1186/s12884-022-04888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background In spite of considerable improvement in maternal and neonatal outcomes over the past decade in India, the current maternal mortality ratio and neonatal mortality rate are far from the Sustainable Development Goal targets due to suboptimal quality of maternity care. A package of interventions for improving quality of intrapartum and immediate postpartum care was co-designed with the Ministry of Health as the Dakshata program and implemented in public sector health facilities in selected districts in the state of Rajasthan of India since June 2015. This article describes the key strategies, interventions, results and challenges from four years of Dakshata program implementation. Methods We have conducted secondary analysis of program data (government data) collected from 202 public facilities across 20 districts of Rajasthan state. The data collected between June–August 2015 (baseline) and the data collected between May-August 2019 (latest) were analyzed. The data sources included: facility assessments, service statistics, monthly progress reports. Results During the period of program implementation, there were 17,94,249 deliveries accounting for 70% of institutional deliveries in intervention districts. As a result of the intervention, there was a notable increase in competency of health care providers, availability of essential resources, achievement of labour room standards and adherence to evidence-based clinical standards. We also observed reductions in the proportion of referrals for pre-eclampsia/eclampsia, postpartum hemorrhage and neonatal asphyxia by 11, 8 and 3 percentage points respectively. Similarly, data revealed a reduction in stillbirth rates in Dakshata intervention facilities (19.3 vs 15.3) compared to non-Dakshata facilities (21.8 vs 18). Conclusions Our experience and findings indicate that the quality of intrapartum and immediate postpartum care can be improved in low- and middle-income countries with the approach presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04888-5.
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Shikuku DN, Jebet J, Nandikove P, Tallam E, Ogoti E, Nyaga L, Mutsi H, Bashir I, Okoro D, Bar Zeev S, Ameh C. Improving midwifery educators' capacity to teach emergency obstetrics and newborn care in Kenya universities: a pre-post study. BMC MEDICAL EDUCATION 2022; 22:749. [PMID: 36316670 PMCID: PMC9623932 DOI: 10.1186/s12909-022-03827-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND International Confederation of Midwives and World Health Organization recommend core competencies for midwifery educators for effective theory and practical teaching and practice. Deficient curricula and lack of skilled midwifery educators are important factors affecting the quality of graduates from midwifery programmes. The objective of the study was to assess the capacity of university midwifery educators to deliver the updated competency-based curriculum after the capacity strengthening workshop in Kenya. METHODS The study used a quasi-experimental (pre-post) design. A four-day training to strengthen the capacity of educators to deliver emergency obstetrics and newborn care (EmONC) within the updated curriculum was conducted for 30 midwifery educators from 27 universities in Kenya. Before-after training assessments in knowledge, two EmONC skills and self-perceived confidence in using different teaching methodologies to deliver the competency-based curricula were conducted. Wilcoxon signed-rank test was used to compare the before-after knowledge and skills mean scores. McNemar test was used to compare differences in the proportion of educators' self-reported confidence in applying the different teaching pedagogies. P-values < 0.05 were considered statistically significant. FINDINGS Thirty educators (7 males and 23 females) participated, of whom only 11 (37%) had participated in a previous hands-on basic EmONC training - with 10 (91%) having had the training over two years beforehand. Performance mean scores increased significantly for knowledge (60.3% - 88. %), shoulder dystocia management (51.4 - 88.3%), newborn resuscitation (37.9 - 89.1%), and overall skill score (44.7 - 88.7%), p < 0.0001. The proportion of educators with confidence in using different stimulatory participatory teaching methods increased significantly for simulation (36.7 - 70%, p = 0.006), scenarios (53.3 - 80%, p = 0.039) and peer teaching and support (33.3 - 63.3%, p = 0.022). There was improvement in use of lecture method (80 - 90%, p = 0.289), small group discussions (73.3 - 86.7%, p = 0.344) and giving effective feedback (60 - 80%, p = 0.146), although this was not statistically significant. CONCLUSION Training improved midwifery educators' knowledge, skills and confidence to deliver the updated EmONC-enhanced curriculum. To ensure that midwifery educators maintain their competence, there is need for structured regular mentoring and continuous professional development. Besides, there is need to cascade the capacity strengthening to reach more midwifery educators for a competent midwifery workforce.
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Affiliation(s)
- Duncan N Shikuku
- Liverpool School of Tropical Medicine (Kenya), P.O. Box 24672-00100, Nairobi, Kenya
- Liverpool School of Tropical Medicine (UK), L3 5QA Liverpool, UK
| | - Joyce Jebet
- University of Nairobi, P. O. Box 19676-00100, Nairobi, Kenya
| | - Peter Nandikove
- Masinde Muliro University of Science and Technology, P.O. Box 190-50100, Kakamega, Kenya
| | - Edna Tallam
- Nursing Council of Kenya, P.O. Box 20056-00200, Nairobi, Kenya
| | - Evans Ogoti
- Moi University, P.O. Box 4606 – 30100, Eldoret, Kenya
| | - Lucy Nyaga
- Liverpool School of Tropical Medicine (Kenya), P.O. Box 24672-00100, Nairobi, Kenya
| | - Hellen Mutsi
- Department of Family Health, Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya
| | - Issak Bashir
- Department of Family Health, Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya
| | - Dan Okoro
- United Nations Population Fund Kenya, P.O. Box 30218-00100, Nairobi, Kenya
| | - Sarah Bar Zeev
- Technical Division, United Nations Population Fund, 10158 New York, NY USA
| | - Charles Ameh
- Liverpool School of Tropical Medicine (UK), L3 5QA Liverpool, UK
- University of Nairobi, P. O. Box 19676-00100, Nairobi, Kenya
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11
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de Melo BCP, Falbo AR, Souza ES, Muijtjens AMM, Van Merriënboer JJG, Van der Vleuten CPM. The limited use of instructional design guidelines in healthcare simulation scenarios: an expert appraisal. Adv Simul (Lond) 2022; 7:30. [PMID: 36153603 PMCID: PMC9509554 DOI: 10.1186/s41077-022-00228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Systematic reviews on simulation training effectiveness have pointed to the need to adhere to evidence-based instructional design (ID) guidelines. ID guidelines derive from sound cognitive theories and aim to optimize complex learning (integration of knowledge, skills, and attitudes) and learning transfer (application of acquired knowledge and skills in the workplace). The purpose of this study was to explore adherence to ID guidelines in simulation training programs for dealing with postpartum hemorrhage (PPH), a high-risk situation and the leading cause of maternal mortality worldwide. Methods A total of 40 raters analyzed simulation training programs as described in 32 articles. The articles were divided into four subsets of seven articles and one subset of four articles. Each subset was judged by seven to ten raters on adherence to ID guidelines. The 5-point Likert score rating scale was based on Merrill’s First Principles of Instruction and included items relating to key ID features categorized into five subscales: authenticity, activation of prior knowledge, demonstration, application, and integration/transfer. The authors searched for articles published in English between January 2007 and March 2017 in PubMed, Eric, and Google Scholar and calculated the mean Likert-scale score, per subscale, and interrater reliability (IRR). Results The mean Likert-scale scores calculated for all subscales were < 3.00. For the number of raters used to judge the papers in this study (varying between 7 and 10), the IRR was found to be excellent for the authenticity and integration/transfer subscales, good-to-excellent for the activation of prior knowledge and application subscales, and fair-to-good for the demonstration subscale. Conclusion The results demonstrate a paucity of the description of adherence to evidence-based ID guidelines in current simulation trainings for a high-risk situation such as PPH. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-022-00228-x.
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Chebet I, Izudi J. Patterns and levels of serum electrolyte imbalance among women with obstructed labor in Uganda: A cross-sectional study. Midwifery 2022; 115:103486. [PMID: 36152598 DOI: 10.1016/j.midw.2022.103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/06/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine the patterns and levels of imbalance in sodium, potassium, and chloride electrolytes, and the factors associated with each electrolyte imbalance among women with obstructed labor. DESIGN In this cross-sectional study, we collected data on personal and obstetric factors using a structured questionnaire. We drew 3 mls of blood from the antecubital vein and analyzed for sodium, potassium, and chloride ions using Cobas Integra 400. Multivariable logistic regression was employed to analyze factors independently associated with each electrolyte imbalance. SETTING Obstetrics and Gynaecology Unit, Mulago National Referral Hospital, Kampala, Uganda. PARTICIPANTS Women with obstructed labor. MEASUREMENTS Imbalance in sodium, potassium, and chloride electrolytes, measured on a binary scale using the normal third-trimester pregnancy electrolyte values: 130-148 mmol/Litre for sodium, 3.3-5.1 mmol/Litre for potassium, and 97-109 mmol/Litre for chloride. Women with electrolyte values outside the respective normal ranges were regarded as having an imbalance. FINDINGS We studied 299 women and found 22/299 (7.4%) had sodium imbalance, 254/299 (84.9%) had potassium imbalance, and 284/299 (95.0%) had chloride imbalance. In multivariable logistic regression analysis, herbal medicine use was associated with sodium imbalance (adjusted odds ratio (aOR), 2.72; 95% confidence interval (CI), 1.11-6.95). KEY CONCLUSIONS Potassium and chloride imbalances were more prevalent among women with obstructed labor relative to sodium imbalance. Herbal medicine use during pregnancy is associated with a higher likelihood of sodium electrolyte imbalance. IMPLICATIONS FOR PRACTICE There is a need to routinely monitor women with obstructed labor for electrolyte imbalance.
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Affiliation(s)
- Irene Chebet
- Gynecology and Obstetrics Unit, Soroti Regional Referral Hospital, Soroti City, Uganda. Box 289, Soroti City, Uganda.
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara City, Uganda. Box 1410, Mbarara City, Uganda.
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13
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Shikuku DN, Nyaoke I, Maina O, Eyinda M, Gichuru S, Nyaga L, Iman F, Tallam E, Wako I, Bashir I, Allott H, Ameh C. The determinants of staff retention after Emergency Obstetrics and Newborn Care training in Kenya: a cross-sectional study. BMC Health Serv Res 2022; 22:872. [PMID: 35794569 PMCID: PMC9261014 DOI: 10.1186/s12913-022-08253-2] [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: 05/01/2021] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Kenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmONC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmONC training in Kenya. Methods A cross-sectional review of EmONC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January–February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed. Results A total of 927 SHP were trained from 2014–2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p < 0.05). Interval from training in years (1 year, AOR = 4.2 (2.1–8.4); cadre (nurse/midwives, AOR = 2.5 (1.4–4.5); and county (Uasin Gishu AOR = 9.5 (4.6- 19.5), Kilifi AOR = 4.0 (2.1–7.7) and Taita Taveta AOR = 1.9 (1.1–3.5), p < 0.05, were significant determinants of staff retention in the maternity departments. Conclusion Retention of EmONC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmONC training.
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Affiliation(s)
- Duncan N Shikuku
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya.
| | - Irene Nyaoke
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Onesmus Maina
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Martin Eyinda
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Sylvia Gichuru
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | - Lucy Nyaga
- Liverpool School of Tropical Medicine, P.O. Box, Nairobi, 24672-00100, Kenya
| | | | | | - Ibrahim Wako
- Clinical Officers Council of Kenya, Nairobi, Kenya
| | - Issak Bashir
- Department of Family Health, Ministry of Health, Nairobi, Kenya
| | - Helen Allott
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Charles Ameh
- Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
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Marcus JK, Fawcus S. Clinical algorithms for management of third stage abnormalities. BJOG 2022. [PMID: 35411672 DOI: 10.1111/1471-0528.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
AIMS To develop algorithms for identifying, managing and monitoring postpartum haemorrhage (PPH) and other third stage of labour abnormalities after vaginal delivery. POPULATION Women with low-risk singleton term pregnancies who have had a vaginal delivery. SETTING Hospital settings with a particular focus on healthcare facilities in low- and middle-income countries (LMICs). SEARCH STRATEGY Searches for international and national guidance documents, research databases (Cochrane, Medline and CINAHL) and published systematic reviews. Searches were limited to work published in English between 1 January 2008 and 31 December 2018. CASE SCENARIOS Four interlinked case scenarios were identified for algorithm development: (1) an approach to PPH after vaginal delivery, (2) uterine atony, (3) genital tract trauma and (4) retained placenta/placental products. CONCLUSIONS The development of clear approaches to the assessment, resuscitation, treatment and monitoring of the four case scenarios are presented as algorithms, based on available evidence. They need to be field tested and evaluated for effectiveness, and may be adapted for electronic decision support tools using artificial intelligence in different settings. Further research is needed around multimodal sequential packages of care for PPH, conservative surgical measures, resuscitation in LMICs, and how a respectful maternity care focus can be incorporated into the algorithms. TWEETABLE ABSTRACT Algorithm development for standardised approaches to managing PPH in low-resource settings.
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Affiliation(s)
- J K Marcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Fawcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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15
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Evaluation of capacity to deliver emergency obstetrics and newborn care updated midwifery and reproductive health training curricula in Kenya: Before and after study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Kumar A, Ameh C. Start here- principles of effective undergraduate training. Best Pract Res Clin Obstet Gynaecol 2021; 80:114-125. [PMID: 34952793 DOI: 10.1016/j.bpobgyn.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/02/2022]
Abstract
Obstetric and gynaecology undergraduate training is an intense time for learners as they encounter various health conditions related to women's health and also learn about pregnancy care and birth. The experience is directed to familiarise students with basic clinical management of gynaecological conditions, also develop communication and related core examination and procedural skills. Similarly, midwifery training encompasses independent care of low-risk pregnant women and assist in care of high-risk pregnancy in partnership with obstetricians. Although its necessary to acquaint most learners with core clinical skills in obstetrics and gynaecology, learning opportunities on patients can be limited, due to the intrusive nature of women's health examination. Simulation Based Education (SBE) can facilitate learning hands-on clinical examination and procedural skills, using realistic part-task and high-fidelity simulators prior to approaching patients. This can apply to both medical and midwifery undergraduate training, further creating opportunities for professional interaction and shared learning space to facilitate interprofessional education. IPE has been shown to improve professional relationships in practicing clinicians. This learning pedagogy can be applied in the undergraduate setting as well, to decrease risk of conflict and appreciate roles of other interprofessional staff in future clinical practice. In this chapter we highlight some challenges faced by medical and midwifery undergraduates in their learning from a global perspective. We also describe some teaching and learning initiatives that can be applicable across various settings of obstetrics, gynaecology medical undergraduate and midwifery teaching with relevant case studies to facilitate new graduates preparedness for practice.
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Affiliation(s)
- Arunaz Kumar
- Obstetrics and Gynaecology Monash Health, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
| | - Charles Ameh
- Emergency Obstetric Care and Quality of Care Unit, International Public Health Department, Liverpool School of Tropical Medicine, L3 5QA, United Kingdom.
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17
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Sharma G, Molla YB, Budhathoki SS, Shibeshi M, Tariku A, Dhungana A, Bajracharya B, Mebrahtu GG, Adhikari S, Jha D, Mussema Y, Bekele A, Khadka N. Analysis of maternal and newborn training curricula and approaches to inform future trainings for routine care, basic and comprehensive emergency obstetric and newborn care in the low- and middle-income countries: Lessons from Ethiopia and Nepal. PLoS One 2021; 16:e0258624. [PMID: 34710115 PMCID: PMC8553030 DOI: 10.1371/journal.pone.0258624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Program managers routinely design and implement specialised maternal and newborn health trainings for health workers in low- and middle-income countries to provide better-coordinated care across the continuum of care. However, in these countries details on the availability of different training packages, skills covered in those training packages and the gaps in their implementation are patchy. This paper presents an assessment of maternal and newborn health training packages to describe differences in training contents and implementation approaches used for a range of training packages in Ethiopia and Nepal. We conducted a mixed-methods study. The quantitative assessment was conducted using a comprehensive assessment questionnaire based on validated WHO guidelines and developed jointly with global maternal and newborn health experts. The qualitative assessment was conducted through key informant interviews with national stakeholders involved in implementing these training packages and working with the Ministries of Health in both countries. Our quantitative analysis revealed several key gaps in the technical content of maternal and newborn health training packages in both countries. Our qualitative results from key informant interviews provided additional insights by highlighting several issues with trainings related to quality, skill retention, logistics, and management. Taken together, our findings suggest four key areas of improvement: first, training materials should be updated based on the content gaps identified and should be aligned with each other. Second, trainings should address actual health worker performance gaps using a variety of innovative approaches such as blended and self-directed learning. Third, post-training supervision and ongoing mentoring need to be strengthened. Lastly, functional training information systems are required to support planning efforts in both countries.
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Affiliation(s)
- Gaurav Sharma
- Society of Public Health Physicians, Kathmandu, Nepal
- * E-mail:
| | - Yordanos B. Molla
- USAID’s Maternal and Child Survival Program/Save the Children, Washington, DC, United States of America
| | | | | | | | - Adhish Dhungana
- USAID’s Maternal and Child Survival Program/Save The Children, Kathmandu, Nepal
| | | | | | | | - Deepak Jha
- Child Health Division, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Abeba Bekele
- USAID’s Maternal and Child Survival Program/Save The Children, Addis Ababa, Ethiopia
| | - Neena Khadka
- USAID’s Maternal and Child Survival Program/Save the Children, Washington, DC, United States of America
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Mizerero SA, Wilunda C, Musumari PM, Ono-Kihara M, Mubungu G, Kihara M, Nakayama T. The status of emergency obstetric and newborn care in post-conflict eastern DRC: a facility-level cross-sectional study. Confl Health 2021; 15:61. [PMID: 34380531 PMCID: PMC8356431 DOI: 10.1186/s13031-021-00395-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Pregnancy-related mortality remains persistently higher in post-conflict areas. Part of the blame lies with continued disruption to vital care provision, especially emergency obstetric and newborn care (EmONC). In such settings, assessment of EmONC is essential for data-driven interventions needed to reduce preventable maternal and neonatal mortality. In the North Kivu Province (NKP), the epicentre of armed conflict in eastern Democratic Republic of the Congo (DRC) between 2006 and 2013, the post-conflict status of EmONC is unknown. We assessed the availability, use, and quality of EmONC in 3 health zones (HZs) of the NKP to contribute to informed policy and programming in improving maternal and newborn health (MNH) in the region. Method A cross-sectional survey of all 42 public facilities designated to provide EmONC in 3 purposively selected HZs in the NKP (Goma, Karisimbi, and Rutshuru) was conducted in 2017. Interviews, reviews of maternity ward records, and observations were used to assess the accessibility, use, and quality of EmONC against WHO standards. Results Only three referral facilities (two faith-based facilities in Goma and the MSF-supported referral hospital of Rutshuru) met the criteria for comprehensive EmONC. None of the health centres qualified as basic EmONC, nor could they offer EmONC services 24 h, 7 days a week (24/7). The number of functioning EmONC per 500,000 population was 1.5. Assisted vaginal delivery was the least performed signal function, followed by parenteral administration of anticonvulsants, mainly due to policy restrictions and lack of demand. The 3 HZs fell short of WHO standards for the use and quality of EmONC. The met need for EmONC was very low and the direct obstetric case fatality rate exceeded the maximum acceptable level. However, the proportion the proportion of births by caesarean section in EmONC facilities was within acceptable range in the HZs of Goma and Rutshuru. Overall, the intrapartum and very early neonatal death rate was 1.5%. Conclusion This study provides grounds for the development of coordinated and evidence-based programming, involving local and external stakeholders, as part of the post-conflict effort to address maternal and neonatal morbidity and mortality in the NKP. Particular attention to basic EmONC is required, focusing on strengthening human resources, equipment, supply chains, and referral capacity, on the one hand, and on tackling residual insecurity that might hinder 24/7 staff availability, on the other.
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Affiliation(s)
- Serge-André Mizerero
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan.
| | - Calistus Wilunda
- African Population and Health Research Centre, Manga Close, P.O. Box 10787-00100, Nairobi, Kenya
| | - Patou Masika Musumari
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.,International Institute of Socio-Epidemiology, Kitagosho-cho, Sakyo-ku, Kyoto, 606-8336, Japan
| | - Masako Ono-Kihara
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Gerrye Mubungu
- Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Masahiro Kihara
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takeo Nakayama
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
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Nkhwalume L, Mashalla Y. Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana. Afr Health Sci 2021; 21:51-58. [PMID: 34447424 PMCID: PMC8367308 DOI: 10.4314/ahs.v21i1.9s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Maternal mortality rate remains a challenge in many developing countries. Objectives This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality. Methods Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Participants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach. Results Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised. Conclusion Strengthening health education at health facility levels, stakeholders' involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.
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Affiliation(s)
| | - Yohana Mashalla
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Komolafe AO, Olowokere AE, Irinoye OO. Assessment of integration of emergency obstetric and newborn care in maternal and newborn care in healthcare facilities in Osun State, Nigeria. PLoS One 2021; 16:e0249334. [PMID: 33857184 PMCID: PMC8049269 DOI: 10.1371/journal.pone.0249334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/16/2021] [Indexed: 11/18/2022] Open
Abstract
The integration of emergency obstetric and newborn care (EmONC) into maternal and newborn care is essential for its effectiveness to avert preventable maternal and newborn deaths in healthcare facilities. This study used a theory-oriented quantitative approach to document the reported extent of EmONC integration, and its relationship with EmONC training, guidelines availability and level of healthcare facility. A descriptive cross-sectional study was conducted among five hundred and five (505) healthcare providers and facility managers across the three levels of healthcare delivery. An adapted questionnaire from NoMad instrument was used to collect data on the integration of EmONC from the study participants. Ethical approval was obtained and informed consents taken from the participants. Both descriptive (frequency, percentage, mean and median) and inferential analyses (Kruskal Wallis and Mann Whitney tests) were done with statistical significance level of p<0.05 using STATA 14. The mean age of respondents was 38.68±8.27. The results showed that the EmONC integration median score at the three levels of healthcare delivery was high (77 (IQR = 83–71)). The EmONC integration median score were 76 (IQR = 84–70), 76 (IQR = 80–68) and 78 (IQR = 84–74) in the primary, secondary and tertiary healthcare facilities respectively. Integration of EmONC was highest (83 (IQR = 87–78)) among healthcare providers who had EmONC training and also had EmONC guidelines made available to them. There were significant differences in EmONC integration at the three levels of healthcare delivery (p = 0.046), among healthcare providers who had EmONC training and those with EmONC guidelines available in their maternity units (p = 0.001). EmONC integration was reportedly high and significantly associated with EmONC training and availability of guidelines. However, the congruence of reported and actual extent of integration of EmONC at the three levels of healthcare delivery still need validation as such would account for the implementation success and maternal-neonatal outcomes.
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Abstract
OBJECTIVE To assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries. SETTINGS Bangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe. PARTICIPANTS Medical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138). OUTCOME MEASURES Expectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC. RESULTS UK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development. CONCLUSION Healthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers' knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.
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Affiliation(s)
- Mary McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Borovac-Pinheiro A, Priyadarshani P, Burke TF. A review of postpartum hemorrhage in low-income countries and implications for strengthening health systems. Int J Gynaecol Obstet 2021; 154:393-399. [PMID: 33529365 DOI: 10.1002/ijgo.13618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/13/2020] [Accepted: 01/21/2021] [Indexed: 11/09/2022]
Abstract
Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. Disparities in PPH-associated survival between high and low-/middle-income countries reflect an imperative for low-resource countries to improve strategies for rapid diagnosis and treatment. A review of current PPH diagnosis, prevention, treatment, and access to care in low-income countries has been used to understand, extract, and report the challenges that public health systems face in trying to solve the marked global disparity in PPH outcomes. Improvement in PPH survival begins with holistic strengthening of each step along the continuum of care in health systems and should include performance feedback measures and quality-of-care research.
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Affiliation(s)
- Anderson Borovac-Pinheiro
- Global Health Innovation Lab, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Preeti Priyadarshani
- Global Health Innovation Lab, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Thomas F Burke
- Global Health Innovation Lab, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard T, H. Chan School of Public Health, Boston, MA, USA
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23
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Quality and women's satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review. BMC Pregnancy Childbirth 2020; 20:682. [PMID: 33176732 PMCID: PMC7656726 DOI: 10.1186/s12884-020-03339-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/15/2020] [Indexed: 01/23/2023] Open
Abstract
Background sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women. Methods Six electronic databases were systematically searched for primary data studies (2009–2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility. Results Seventeen articles were included in the study. Most studies were quantitative (n = 11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals. Trial registration Systematic review registration: PROSPERO registration CRD42018114261. Supplementary information Supplementary information accompanies this paper at 10.1186/s12884-020-03339-3.
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Alwy Al-Beity F, Pembe AB, Kwezi HA, Massawe SN, Hanson C, Baker U. "We do what we can do to save a woman" health workers' perceptions of health facility readiness for management of postpartum haemorrhage. Glob Health Action 2020; 13:1707403. [PMID: 31928163 PMCID: PMC7006654 DOI: 10.1080/16549716.2019.1707403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: In many low-resource settings, in-service training is a common strategy to improve the performance of health workers and ultimately reduce the persistent burden of maternal mortality and morbidities. An evaluation of the Helping Mothers Survive Bleeding After Birth (HMS BAB) training as a single-component intervention in Tanzania found some positive albeit limited effect on clinical management and reduction of postpartum haemorrhage (PPH). Aim: In order to better understand these findings, and particularly the contribution of contextual factors on the observed effects, we explored health workers’ perceptions of their health facilities’ readiness to provide PPH care. Methods: We conducted 7 focus group discussions (FGDs) and 12 in-depth interviews (IDIs) in purposively selected intervention districts in the HMS BAB trial. FGDs and IDIs were audio-recorded, transcribed and translated verbatim. Thematic analysis, using both inductive and deductive approaches, was applied with the help of MAXQDA software. Results: Health workers perceive that their facilities have a low readiness to provide PPH care, leading to stressful situations and suboptimal clinical management. They describe inconsistencies in essential supplies, fluctuating availability of blood for transfusion, and ineffective referral system. In addition, there are challenges in collaboration, communication and leadership support, which is perceived to prevent effective management of cases within the facility as well as in referral situations. Health workers strive to provide life-saving care to women with PPH despite the perceived challenges. In some health facilities, health workers perceive supportive clinical leadership as motivating in providing good care. Conclusion: The potential positive effects of single-component interventions such as HMS BAB training on clinical outcome may be constraint by poor health facility readiness, including communication, leadership and referral processes that need to be addressed.
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Affiliation(s)
- Fadhlun Alwy Al-Beity
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hilda A Kwezi
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siriel N Massawe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hanson
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ulrika Baker
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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25
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Geleto A, Chojenta C, Taddele T, Loxton D. Perceptions of midwives on the quality of emergency obstetric care at hospitals in Ethiopia: A qualitative explanatory study. Midwifery 2020; 90:102814. [PMID: 32763670 DOI: 10.1016/j.midw.2020.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Ethiopia, maternal mortality remains an important public health concern. High maternal mortality is attributed in part to the poor quality of obstetric care. This study was designed to investigate perceptions of midwives about the quality of emergency obstetric care provided at hospitals in the Harari region of Ethiopia. METHODS An explanatory qualitative study was conducted from December 2018 to February 2019 at public and private hospitals in the Harari region, Ethiopia. The data were obtained through in-depth interviews with 12 midwives working in maternity units. The interviewers took notes and audio-recorded the respondents' descriptions. Braun and Clarke's thematic analysis method was employed to analyse the data using Nvivo 12 qualitative data analysis software. RESULTS Poorly designed infrastructure, including a scarcity of beds, rooms and ambulances challenged the provision of quality obstetric services. Midwives working at hospitals were inadequate in number and training opportunities were scarce. Language barriers affected effective communication between patients and caregivers. Frequent disruptions to medical supplies resulted in the provision of suboptimal obstetric care as it created an inability to provide appropriate medications. A lack of treatment protocols, poor supportive supervision, and poor staff motivation impaired the provision of quality obstetric care at hospitals, although disparities were observed among hospitals in this regard. CONCLUSIONS Several interdependent factors limited the quality of emergency obstetric care at hospitals in the region. Quality improvement initiatives and equitable resource distribution for hospitals need to be enhanced while the existing health infrastructure, resources and service delivery management need to be strengthened.
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Affiliation(s)
- Ayele Geleto
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Tefera Taddele
- Health System and Reproductive Health Directorate, the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
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Ugwa E, Kabue M, Otolorin E, Yenokyan G, Oniyire A, Orji B, Okoli U, Enne J, Alobo G, Olisaekee G, Oluwatobi A, Oduenyi C, Aledare A, Onwe B, Ishola G. Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers on day of birth care in Nigeria; a cluster randomized controlled trial. BMC Health Serv Res 2020; 20:586. [PMID: 32590979 PMCID: PMC7318405 DOI: 10.1186/s12913-020-05450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to compare health workers knowledge and skills competencies between those trained using the onsite simulation-based, low-dose, high frequency training plus mobile mentoring (LDHF/m-mentoring) and the ones trained through traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period. Methods A prospective cluster randomized controlled trial was conducted by enrolling 299 health workers who provided healthcare to mothers and their babies on the day of birth in 60 health facilities in Kogi and Ebonyi states. These were randomized to either LDHF/m-mentoring (intervention, n = 30 facilities) or traditional group-based training (control, n = 30 facilities) control arm. They received Basic Emergency Obstetrics and Newborn Care (BEmONC) training with simulated practice using anatomic models and role-plays. The control arm was trained offsite while the intervention arm was trained onsite where they worked. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions (MCQs) and objective structured clinical examinations (OSCEs) mean scores were compared; p-value < 0.05 was considered statistically significant. Qualitative data were also collected and content analysis was conducted. Results The mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at end line (p < 0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p < 0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities. Conclusion The LDHF/m-mentoring intervention is more effective than TRAD approach in improving health workers’ skills acquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery. Trial registration The trial was retrospectively registered on August 24, 2017 at ClinicalTrials.Gov: NCT03269240.
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Affiliation(s)
- Emmanuel Ugwa
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria.
| | - Mark Kabue
- USAID's Maternal and Child Survival Program/Jhpiego-, 1615 Thames St, Baltimore, MD, 21231, USA
| | - Emmanuel Otolorin
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Gayane Yenokyan
- The Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Adetiloye Oniyire
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Bright Orji
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Ugo Okoli
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Joseph Enne
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Gabriel Alobo
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Gladys Olisaekee
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Adebayo Oluwatobi
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Chioma Oduenyi
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
| | - Adekunle Aledare
- Department of Public Health, State Ministry of Health, Lokoja, Kogi State, Nigeria
| | - Boniface Onwe
- Department of Public Health, State Ministry of Health, Abakiliki, Ebonyi State, Nigeria
| | - Gbenga Ishola
- USAID's Maternal and Child Survival Program/Jhpiego, Nigeria, 971 Reuben Okoya Crescent, Wuye District, Abuja, Nigeria
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27
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Mahwasane T, Maputle MS, Simane-Netshisaulu KG, Malwela T. Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa. Ann Glob Health 2020; 86:10. [PMID: 32064228 PMCID: PMC7006596 DOI: 10.5334/aogh.2555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life. Purpose The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa. Methods Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method. Findings Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision. Conclusion Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.
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28
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Ameh CA, Mdegela M, White S, van den Broek N. The effectiveness of training in emergency obstetric care: a systematic literature review. Health Policy Plan 2020; 34:257-270. [PMID: 31056670 PMCID: PMC6661541 DOI: 10.1093/heapol/czz028] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before-after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
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Affiliation(s)
- Charles A Ameh
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sarah White
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Banke-Thomas A, Maua J, Madaj B, Ameh C, van den Broek N. Perspectives of stakeholders on emergency obstetric care training in Kenya: a qualitative study. Int Health 2020; 12:11-18. [PMID: 30806665 PMCID: PMC6964219 DOI: 10.1093/inthealth/ihz007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Background This study explores stakeholders’ perceptions of emergency obstetric care (EmOC) ‘skills-and-drills’-type training including the outcomes, strengths, weaknesses, opportunities and threats of the intervention in Kenya. Methods Stakeholders who either benefited from or contributed to EmOC training were purposively sampled. Semi-structured topic guides were used for key informant interviews and focus group discussions. Following verbatim transcriptions of recordings, the thematic approach was used for data analysis. Results Sixty-nine trained healthcare providers (HCPs), 114 women who received EmOC and their relatives, 30 master trainers and training organizers, and six EmOC facility/Ministry of Health staff were recruited. Following training, deemed valuable for its ‘hands-on’ approach and content by HCPs, women reported that they experienced improvements in the quality of care provided. HCPs reported that training led to improved knowledge, skills and attitudes, with improved care outcomes. However, they also reported an increased workload. Implementing stakeholders stressed the need to explore strategies that help to maximize and sustain training outcomes. Conclusions The value of EmOC training in improving the capacity of HCPs and outcomes for mothers and newborns is not just ascribed but felt by beneficiaries. However, unintended outcomes such as increased workload may occur and need to be systematically addressed to maximize training gains.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.,Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Judith Maua
- Liverpool School of Tropical Medicine, Nairobi, Kenya
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Charles Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Sigalet EL, Matovelo D, Brenner JL, Boniphace M, Ndaboine E, Mwaikasu L, Shabani G, Kabirigi J, Mannerfeldt J, Singhal N. Rater training for standardised assessment of Objective Structured Clinical Examinations in rural Tanzania. BMJ Paediatr Open 2020; 4:e000856. [PMID: 33324763 PMCID: PMC7722831 DOI: 10.1136/bmjpo-2020-000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe a simulation-based rater training curriculum for Objective Structured Clinical Examinations (OSCEs) for clinician-based training for frontline staff caring for mothers and babies in rural Tanzania. BACKGROUND Rater training for OSCE evaluation is widely embraced in high-income countries but not well described in low-income and middle-income countries. Helping Babies Breathe, Essential Care for Every Baby and Bleeding after Birth are standardised training programmes that encourage OSCE evaluations. Studies examining the reliability of assessments are rare. METHODS Training of raters occurred over 3 days. Raters scored selected OSCEs role-played using standardised learners and low-fidelity mannikins, assigning proficiency levels a priori. Researchers used Zabar's criteria to critique rater agreement and mitigate measurement error during score review. Descriptive statistics, Fleiss' kappa and field notes were used to describe results. RESULTS Six healthcare providers scored 42 training scenarios. There was moderate rater agreement across all OSCEs (κ=0.508). Kappa values increased with Helping Babies Breathe (κ=0.28-0.48) and Essential Care for Every Baby (κ=0.42-0.77) by day 3 of training, but not with Bleeding after Birth (κ=0.58-0.33). Raters identified average proficiency 50% of the time. CONCLUSION Our study shows that the in-country raters in this study had a hard time identifying average performance despite moderate rater agreement. Rater training is critical to ensure that the potential of training programmes translates to improved outcomes for mothers and babies; more research into the concepts and training for discernment of competence in this setting is necessary.
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Affiliation(s)
- Elaine L Sigalet
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Dismas Matovelo
- Obstetrics and Gynecology, Nursing, Pediatrics, Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Mwanza, Tanzania
| | - Jennifer L Brenner
- Faculty of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Maendeleo Boniphace
- Obstetrics and Gynecology, Nursing, Pediatrics, Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Mwanza, Tanzania
| | - Edgar Ndaboine
- Obstetrics and Gynecology, Nursing, Pediatrics, Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Mwanza, Tanzania
| | - Lusako Mwaikasu
- Obstetrics and Gynecology, Nursing, Pediatrics, Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Mwanza, Tanzania
| | - Girles Shabani
- Obstetrics and Gynecology, Nursing, Pediatrics, Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Mwanza, Tanzania
| | - Julieth Kabirigi
- Obstetrics and Gynecology, Nursing, Pediatrics, Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Mwanza, Tanzania
| | - Jaelene Mannerfeldt
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nalini Singhal
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Shikuku DN, Mukosa R, Peru T, Yaite A, Ambuchi J, Sisimwo K. Reducing intrapartum fetal deaths through low-dose high frequency clinical mentorship in a rural hospital in Western Kenya: a quasi-experimental study. BMC Pregnancy Childbirth 2019; 19:518. [PMID: 31870325 PMCID: PMC6929310 DOI: 10.1186/s12884-019-2673-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/12/2019] [Indexed: 01/10/2023] Open
Abstract
Background Intrapartum fetal mortality can be prevented by quality emergency obstetrics and newborn care (EmONC) during pregnancy and childbirth. This study evaluated the effectiveness of a low-dose high-frequency onsite clinical mentorship in EmONC on the overall reduction in intrapartum fetal deaths in a busy hospital providing midwife-led maternity services in rural Kenya. Methods A quasi-experimental (nonequivalent control group pretest – posttest) design in a midwife-led maternity care hospitals. Clinical mentorship and structured supportive supervision on EmONC signal functions was conducted during intervention. Maternity data at two similar time points: Oct 2015 to July 2016 (pre) and August 2016 to May 2017 (post) reviewed. Indicators of interest at Kirkpatrick’s levels 3 and 4 focusing on change in practice and health outcomes between the two time periods were evaluated and compared through a two-sample test of proportions. Proportions and p-values were reported to test the strength of the evidence after the intervention. Results Spontaneous vaginal delivery was the commonest route of delivery between the two periods in both hospitals. At the intervention hospital, assisted vaginal deliveries (vacuum extractions) increased 13 times (0.2 to 2.5%, P < 0.0001), proportion of babies born with low APGAR scores requiring newborn resuscitation doubled (1.7 to 3.7%, P = 0.0021), proportion of fresh stillbirths decreased 5 times (0.5 to 0.1%, P = 0.0491) and referred cases for comprehensive emergency obstetric care doubled (3.0 to 6.5%, P < 0.0001) with no changes observed in the control hospital. The proportion of live births reduced (98 to 97%, P = 0.0547) at the control hospital. Proportion of macerated stillbirths tripled at the control hospital (0.4 to 1.4%, P = 0.0039) with no change at the intervention hospital. Conclusion Targeted mentorship improves the competencies of nurse/midwives to identify, manage and/or refer pregnancy and childbirth cases and/or complications contributing to a reduction in intrapartum fetal deaths. Scale up of this training approach will improve maternal and newborn health outcomes.
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van den Broek N, Ameh C, Madaj B, Makin J, White S, Hemming K, Moodley J, Pattinson R. Effects of emergency obstetric care training on maternal and perinatal outcomes: a stepped wedge cluster randomised trial in South Africa. BMJ Glob Health 2019; 4:e001670. [PMID: 31798985 PMCID: PMC6861119 DOI: 10.1136/bmjgh-2019-001670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/02/2019] [Accepted: 08/10/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Two-thirds of maternal deaths and 40% of intrapartum-related neonatal deaths are thought to be preventable through emergency obstetric and newborn care (EmOC&NC). The effectiveness of ‘skills and drills’ training of maternity staff in EmOC&NC was evaluated. Methods Implementation research using a stepped wedge cluster randomised trial including 127 of 129 healthcare facilities (HCFs) across the 11 districts in South Africa with the highest maternal mortality. The sequence in which all districts received EmOC&NC training was randomised but could not be blinded. The timing of training resulted in 10 districts providing data before and 10 providing data after EmOC&NC training. Primary outcome measures derived for HCFs are as follows: stillbirth rate (SBR), early neonatal death (ENND) rate, institutional maternal mortality ratio (iMMR) and direct obstetric case fatality rate (CFR), number of complications recognised and managed and CFR by complication. Results At baseline, median SBR (per 1000 births) and ENND rate (per 1000 live births) were 9 (IQR 0–28) and 0 (IQR 0–9). No significant changes following training in EmOC&NC were detected for any of the stated outcomes: SBR (adjusted incidence rate ratio (aIRR) 0.97, 95% CI 0.91 to 1.05), iMMR (aIRR 1.23, 95% CI 0.80 to 1.90), ENND rate (aIRR 1.04, 95% CI 0.92 to 1.17) and direct obstetric CFR (aIRR 1.15, 95% CI 0.66 to 2.02). The number of women who were recognised to need and received EmOC was significantly increased overall (aIRR 1.14, 95% CI 1.02 to 1.27), for haemorrhage (aIRR 1.31, 95% CI 1.13 to 1.52) and for postpartum sepsis (aIRR 1.86, 95% CI 1.17 to 2.95) Conclusion Following EmOC&NC training, healthcare providers are more able to recognise and manage complications at time of birth. This trial did not provide evidence that the intervention was effective in reducing adverse clinical outcomes, but demonstrates randomised evaluations are feasible in implementation research. Trial registration number ISRCTN11224105.
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Affiliation(s)
- Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Charles Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jennifer Makin
- Department of Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Sarah White
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Moodley
- Womens Health and HIV Reaserch unit, University of KwaZulu Natal, Durban, South Africa
| | - Robert Pattinson
- MRC Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa
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Dol J, Campbell-Yeo M, Bulemela J, McMillan D, Abel Z, Nyamtema A, LeBlanc JC. Knowledge acquisition after Helping Babies Survive training in rural Tanzania. Int Health 2019; 11:136-142. [PMID: 30252052 DOI: 10.1093/inthealth/ihy068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/02/2018] [Accepted: 09/13/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While the effectiveness of Helping Babies Breathe (HBB) training in Tanzania has been reported, no published studies of Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB) in this setting have been found. This study compared knowledge before and after HBB, ECEB and ECSB training in Tanzania. METHODS Training was provided to future facilitators (n=16) and learners (n=24) in Tanzania. Using standardized multiple-choice questions, knowledge was assessed pre- and post-HBB and ECEB courses for both learners and facilitators, while ECSB assessment was conducted with facilitators only. A >80% score was considered to be a pass. Paired t-tests were used for hypothesis testing. RESULTS Knowledge significantly improved for both facilitators and learners on HBB and ECEB (p<0.001) and for facilitators on ECSB (p<0.001). After training, learners had difficulty identifying correct responses on one HBB item (21% incorrect) and three ECEB items (25-29% incorrect). After training, facilitators had difficulty identifying correct responses on five ECSB items (22-44% incorrect). CONCLUSIONS Training improved knowledge in Tanzania, but not sufficiently for feeding, especially for low birthweight babies. Targeted training on feeding is warranted both within the Helping Babies Survive program and in preclinical training to improve knowledge and skill to enhance essential newborn care.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Janeth Bulemela
- Tanzanian Training Center for International Health & St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Douglas McMillan
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, & IWK Health Centre, Halifax, NS, Canada
| | - Zabron Abel
- Tanzanian Training Center for International Health, Ifakara
| | - Angelo Nyamtema
- Tanzanian Training Center for International Health & St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - John C LeBlanc
- Departments of Pediatrics, Community Health and Epidemiology and Psychiatry, Dalhousie University & IWK Health Centre, Halifax, NS, Canada
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Itote EW, Fleming LC, Mallinson RK, Gaffney KF, Jacobsen KH. Knowledge of intrapartum care among obstetric care providers in rural Kenya. Int Health 2019; 11:258-264. [PMID: 30383223 DOI: 10.1093/inthealth/ihy078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/07/2018] [Accepted: 09/07/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Kenya did not meet its maternal mortality ratio (MMR) target under the Millennium Development Goals. The aim of this study was to examine the gaps in knowledge of intrapartum care among obstetric care providers (OCPs) in rural Nandi County, Kenya. METHODS This cross-sectional study in 2015 surveyed 326 nurses, midwives, clinical officers and physicians about their knowledge, attitudes and practices related to normal labor and childbirth, immediate newborn care and management of obstetric complications. RESULTS Self-reported intrapartum knowledge among OCPs was insufficient according to accepted international standards. The mean total knowledge score for all OCPs based on a validated 30-question inventory was 62% (range 23-90%). Only 14 providers (4%) scored as 'competent' (a score ≥80%). Scores were higher for OCPs who had received pre- and postemployment emergency obstetric care training and those with higher levels of confidence in their skills. Survey respondents identified a lack of knowledge as one of the greatest barriers to high-quality patient care. CONCLUSIONS Increasing training opportunities for OCPs may improve the quality of obstetric care provided to women in Kenya and other high-MMR locations in sub-Saharan Africa and enable progress toward achieving the ambitious Sustainable Development Goals target for maternal survival.
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Affiliation(s)
- Elizabeth W Itote
- School of Nursing, George Mason University, 4400 University Drive, Fairfax, VA, USA
| | - Lila C Fleming
- Department of Global and Community Health, George Mason University, University Drive, Fairfax, VA, USA
| | - R Kevin Mallinson
- School of Nursing, George Mason University, 4400 University Drive, Fairfax, VA, USA
| | - Kathleen F Gaffney
- School of Nursing, George Mason University, 4400 University Drive, Fairfax, VA, USA
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, University Drive, Fairfax, VA, USA
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Bolan NE, Newman SD, Nemeth LS. Technology-Based Newborn Health Learning Initiatives for Facility-Based Nurses and Midwives in Low- and Middle-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2019. [DOI: 10.1891/2156-5287.8.4.252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSEGiven high neonatal mortality in many low- and middle-income countries, addressing missed opportunities by enhancing the quality of newborn care provided by facility-based nurses and midwives is critical. This scoping review synthesizes and critiques the literature on technology-based newborn health learning initiatives. Kirkpatrick's model is used for training program evaluation.METHODSA literature review was conducted from multiple databases. Articles selected for analysis consisted of original research studies published in peer-reviewed journals from 2012 to 2017.RESULTSTwelve studies fell into two categories: (a) Simulation training in routine neonatal care and newborn resuscitation (n = 9) and (b) eLearning initiatives (n = 3). Most studies evaluated health provider's knowledge and skills before and/or after training (n = 9); fewer evaluated the effect on change in provider practice (n = 3) and/or patient health outcomes (n = 5) (Kirkpatrick levels 3–4). Few studies utilized robust study designs and validated measurement instruments.CONCLUSIONLearning approaches emphasizing simulation training and eLearning initiatives for facility-based health workers hold promise. However, existing simulation literature demonstrates that translation of knowledge gained during simulation into improved clinical outcomes in real births is variable. Additionally, the volume of peer-reviewed evidence demonstrating the potential benefit of eLearning strategies, especially in the neonatal period, is limited.
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Fawcus S. Practical approaches to managing postpartum haemorrhage with limited resources. Best Pract Res Clin Obstet Gynaecol 2019; 61:143-155. [PMID: 31103529 DOI: 10.1016/j.bpobgyn.2019.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/20/2019] [Accepted: 03/31/2019] [Indexed: 10/26/2022]
Abstract
Mortality from postpartum haemorrhage (PPH) is higher in low resource settings due to increased incidence, higher case fatality rates and poor general health of the population. The challenges of managing PPH with limited resources are presented. Feasible interventions for preventing and treating PPH for home births are described. Given that maternity care is organised around levels of care in low resource settings, guidance is provided for what measures can be performed to manage PPH at different levels of care (clinic, community health centre, district hospital, regional and central hospital); and by which cadre (midwife, clinical officer, general doctor, specialist). Effective management of PPH requires on-going training and emergency drills. Reducing mortality from PPH is not possible without available urgent transport from home to facility and between levels of care. In addition, the essential building blocks of the health system must be functional to enable effective management of PPH.
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Affiliation(s)
- Susan Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, H floor Old Main building, Grooteschuur Hospital, Anzio road, Observatory, Cape Town, 7925, South Africa.
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Mobile obstetric and neonatal simulation based skills training in India. Midwifery 2019; 72:14-22. [DOI: 10.1016/j.midw.2019.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/26/2019] [Accepted: 02/06/2019] [Indexed: 11/19/2022]
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de Melo BCP, Van der Vleuten CPM, Muijtjens AMM, Rodrigues Falbo A, Katz L, Van Merriënboer JJG. Effects of an in situ instructional design based postpartum hemorrhage simulation training on patient outcomes: an uncontrolled before-and-after study. J Matern Fetal Neonatal Med 2019; 34:245-252. [PMID: 31023119 DOI: 10.1080/14767058.2019.1606195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: To compare postpartum hemorrhage (PPH) patient outcomes before and after an in situ instructional design based PPH simulation attended by obstetrics and gynecology (OBGYN) residents.Methods: This uncontrolled before-and-after study was conducted in Recife, Brazil including all 1388 women delivering from June to August 2012 and all 1357 delivering from June to August 2013. The 36 OBGYN residents were divided into13 teams of two or three participants and were trained through ID based PPH simulation training with the following eight steps: (1) prior knowledge activation, (2) video demonstration, (3) dual-coding PPH protocol discussion-an image association during the training, (4) training scenario # 1, (5) debriefing, (6) training scenario # 2 with immediate feedback, (7) training scenario # 3, and (8) debriefing with self-assessment. The training scenarios had an increasing level of complexity. The main goal of the training was the adequate management of PPH and situational awareness improvement-the ability to anticipate, recognize, and intercept unfolding error chains. The primary patient outcomes rates used for the before and after comparison were therapeutic uterotonics use within 24 h of birth and blood transfusion. Secondary outcomes were therapeutic oxytocin mean dosage IU within 24 h of birth, postpartum Hb < 6 g/dL, among others. Chi-square test was used for categorical variables comparison and independent t-test for continuous variables.Results: PPH rates were 100 (7.2% of 2012 deliveries) and 80 cases (5.9% of 2013 deliveries), respectively. Comparison of primary post- and pre-simulation outcomes revealed no significant differences. However, in the comparison for therapeutic oxytocin mean dosage IU within 24 h of birth, there was an increase found after the simulation (15.98 ± 7.4 versus 25.1 ± 12.3; p < .001). For all other outcome measures, there were no statistical differences.Conclusions: In situ ID based PPH simulation leads to an increase in the mean dosage of oxytocin after training, in selected cases. This may indicate better situational awareness when managing women with PPH.
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Affiliation(s)
- Brena Carvalho Pinto de Melo
- Centro de Atenção, à Mulher, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Recife, Brazil.,Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.,Medical Course, Faculdade Pernambucana de Saúde (FPS), Recife, Brazil
| | - Cees P M Van der Vleuten
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Arno M M Muijtjens
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Ana Rodrigues Falbo
- Medical Course, Faculdade Pernambucana de Saúde (FPS), Recife, Brazil.,Faculty Development Coordination, Faculdade Pernambucana de Saúde (FPS), Recife, Brazil.,Programa de Pós-Graduação, Recife, Brazil
| | - Leila Katz
- Centro de Atenção, à Mulher, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Recife, Brazil.,Programa de Pós-Graduação, Recife, Brazil
| | - Jeroen J G Van Merriënboer
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Okonofua F, Ntoimo LFC, Ogu R, Galadanci H, Gana M, Adetoye D, Abe E, Okike O, Agholor K, Abdus-salam RA, Randawa A, Abdullahi H, Daneji SM, Omo-Omorodion BI. Assessing the knowledge and skills on emergency obstetric care among health providers: Implications for health systems strengthening in Nigeria. PLoS One 2019; 14:e0213719. [PMID: 30958834 PMCID: PMC6453439 DOI: 10.1371/journal.pone.0213719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/27/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria. STUDY DESIGN A cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period. SETTING Six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country. POPULATION All skilled providers offering EMOC services in the hospitals during the study. METHODS A pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall. RESULTS A total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores. CONCLUSION The knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country. TRIAL REGISTRATION Nigeria Clinical Trials Registry 91540209.
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Affiliation(s)
- Friday Okonofua
- The Women’s Health and Action Research Centre/WHO Implementation Research Group, Benin, Nigeria
- University of Medical Sciences, Ondo, Ondo, Nigeria
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin, Edo, Nigeria
| | - Lorretta Favour Chizomam Ntoimo
- The Women’s Health and Action Research Centre/WHO Implementation Research Group, Benin, Nigeria
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti, Nigeria
| | - Rosemary Ogu
- The Women’s Health and Action Research Centre/WHO Implementation Research Group, Benin, Nigeria
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin, Edo, Nigeria
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers, Nigeria
| | | | | | | | - Eghe Abe
- Central Hospital, Benin, Edo, Nigeria
| | - Ola Okike
- Karshi General Hospital, Federal Capital Territory, Abuja, Nigeria
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Koroma MM, Kamara MA, Keita N, Lokossou VK, Sundufu AJ, Jacobsen KH. Access to Essential Medications and Equipment for Obstetric and Neonatal Primary Care in Bombali District, Sierra Leone. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Alwy Al-Beity F, Pembe A, Hirose A, Morris J, Leshabari S, Marrone G, Hanson C. Effect of the competency-based Helping Mothers Survive Bleeding after Birth (HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania. BMJ Glob Health 2019; 4:e001214. [PMID: 30997164 PMCID: PMC6441296 DOI: 10.1136/bmjgh-2018-001214] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background Training health providers is an important strategy to improve health. We conducted a cluster-randomised two-arm trial in Tanzania to assess the effect of a 1-day competency-based training ‘Helping Mothers Survive Bleeding after Birth (HMS BAB)’ followed by eight weekly drills on postpartum haemorrhage (PPH)-related morbidity and mortality. Methods Twenty districts in four purposefully selected regions in Tanzania included 61 facilities. The districts were randomly allocated using matched pairs to ensure similarity in terms of district health services in intervention and comparison districts. In the 10 intervention districts 331 health providers received the HMS BAB training. The other half continued with standard practices. We used the WHO’s near miss tool to collect information on severe morbidity (near misses) of all women admitted to study facilities. We performed interrupted time series analysis to estimate differences in the change of near miss per delivery rate and case fatality rates. We also assessed implementation of evidence-based preventive and basic management practices for PPH as secondary outcomes. Results We included 120 533 facility deliveries, 6503 near misses and 202 maternal deaths in study districts during study period (November 2014 to January 2017). A significant reduction of PPH near misses was found among women who suffered PPH in the intervention district compared with comparison districts (difference-in-differences of slopes −5.3, 95% CI −7.8 to −2.7, p<0.001) from a baseline PPH-related near miss rate of 71% (95% CI 60% to 80%). There was a significant decrease in the long-term PPH near miss case fatality (difference-in-differences of slopes −4 to 0) (95% CI −6.5 to −1.5, p<0.01) in intervention compared with the comparison districts. The intervention had a positive effect on the proportion of PPH cases treated with intravenous oxytocin (difference-in-differences of slopes 5.2, 95% CI 1.4 to 8.9) (p <0.01). Conclusion The positive effect of the training intervention on PPH morbidity and case fatality suggests that the training addresses important deficits in knowledge and skills. Trial registration number PACTR201604001582128.
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Affiliation(s)
- Fadhlun Alwy Al-Beity
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.,Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Atsumi Hirose
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Jessica Morris
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gaetano Marrone
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Emmanuel A, Kain V, Forster E. The Impact of the World Health Organization Essential Newborn Package on Newborn Care Practices and Survival Rates in Sub-Saharan Africa: A Systematic Literature Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2019. [DOI: 10.1891/2156-5287.9.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sub-Saharan Africa, has the highest child mortality rate in the world (World Health Organization [WHO], 2016). However, there is a paucity of current systematic reviews on the impact of essential newborn care interventions in Africa. Therefore, the aim of this systematic review was to summarize evidence about the impact of essential newborn care interventions in Africa. Numerous databases were searched to retrieve articles that reported interventions in newborn care in Africa. The search was limited to the English language and to articles published between 2007 and 2017. Nine articles were selected for inclusion in this systematic review. Overall, these papers demonstrated an increase in performance of health workers (between 8 and 400%) following a test of knowledge, while health workers practical performance increased by 34%. Moreover, neonatal mortality was reduced by 45%, while perinatal mortality was reduced by 30%. Training healthcare workers is one of the most effective ways of improving newborn care and neonatal survival in Africa. However, there is a need for additional evidence to support this, because none of the reviewed studies assessed the impact of training by examining variables such as trainees' satisfaction with training, the knowledge and skills developed, and the health outcomes achieved.
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Hanson C, Munjanja S, Binagwaho A, Vwalika B, Pembe AB, Jacinto E, Chilinda GK, Donahoe KB, Wanyonyi SZ, Waiswa P, Gidiri MF, Benova L. National policies and care provision in pregnancy and childbirth for twins in Eastern and Southern Africa: A mixed-methods multi-country study. PLoS Med 2019; 16:e1002749. [PMID: 30779738 PMCID: PMC6380547 DOI: 10.1371/journal.pmed.1002749] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/22/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND High-risk pregnancies, such as twin pregnancies, deserve particular attention as mortality is very high in this group. With a view to inform policy and national guidelines development for the Sustainable Development Goals, we reviewed national training materials, guidelines, and policies underpinning the provision of care in relation to twin pregnancies and assessed care provided to twins in 8 Eastern and Southern African countries: Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. METHODS AND FINDINGS We located policies and guidelines by reviewing national repositories and by contacting experts to systematically map country-level maternal and newborn training materials, guidelines, and policies. We extracted recommendations for care for twins spanning ante-, intra-, and postpartum care that typically should be offered during twin pregnancies and childbirth. We compared care provided for mothers of twins to that provided for mothers of singletons during the ante-, intra-, and postpartum period and computed neonatal mortality rates using the most recent Demographic and Health Surveys (DHS) data for each country. There was a paucity of guidance on care specifically for twin or multiple pregnancies: None of the countries provided clear guidance on additional number of antenatal care visits or specific antenatal content, while 7 of the 8 countries recommended twins to be delivered in a comprehensive emergency obstetric and neonatal care facility. These results were mirrored by DHS results of 73,462 live births (of which 1,360 were twin) indicating that twin pregnancies did not receive more frequent or intensified antenatal care. The percentage of twin deliveries in hospitals varied from 25.3% in Mozambique to 63.0% in Kenya, and women with twin deliveries were between 5 and 27 percentage points more likely to deliver in hospitals compared to women with singleton live births; this difference was significant in 5 of the 8 countries (t test p < 0.05). The percentage of twin deliveries by cesarean section varied from 9% in Mozambique to 36% in Rwanda. The newborn mortality rate among twins, adjusted for maternal age and parity, was 4.6 to 7.2 times higher for twins compared to singletons in all 8 countries. CONCLUSIONS Despite the limited sample size and the limited number of clinically relevant services evaluated, our study provided evidence that mothers of twins receive insufficient care and that mortality in twin newborns is very high in Eastern and Southern Africa. Most countries have insufficient guidelines for the care of twins. While our data do not allow us to make a causal link between insufficient guidelines and insufficient care, they call for an assessment and reconceptualisation of policies to reduce the unacceptably high mortality in twins in Eastern and Southern Africa.
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Affiliation(s)
- Claudia Hanson
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
- Department of Public Health Sciences–Global Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Stephen Munjanja
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Andrea B. Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Elsa Jacinto
- Women’s and Children’s Health Department, National Directorate for Public Health, Ministry of Health, Maputo, Mozambique
| | - George K. Chilinda
- Department of Obstetrics and Gynaecology, Medical College, Blantyre, Malawi
| | | | - Sikolia Z. Wanyonyi
- Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Peter Waiswa
- Department of Public Health Sciences–Global Health, Karolinska Institutet, Stockholm, Sweden
- College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Muchabayiwa F. Gidiri
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Banke-Thomas A, Madaj B, van den Broek N. Social return on investment of emergency obstetric care training in Kenya. BMJ Glob Health 2019; 4:e001167. [PMID: 30775008 PMCID: PMC6352828 DOI: 10.1136/bmjgh-2018-001167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/17/2018] [Accepted: 11/23/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction Emergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology. Methods Mixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions. Results Trained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred. Conclusion EmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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A pilot study on the simulation-based training for Ethiopia skilled birth attendants. Nurse Educ Pract 2018; 34:130-138. [PMID: 30529835 DOI: 10.1016/j.nepr.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/21/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022]
Abstract
This simulation-based Ethiopia Midwife Train-the-Trainer program for skilled birth attendants is one part of the China-UK Global Health Support Program (GHSP) activities and an approach to improving the Ethiopia trainers' midwifery teaching skills. This pilot study aimed to evaluate the effectiveness of a simulation-based training for Ethiopia skilled birth attendants. This program was divided into three stages. In Stage 1, Fudan team trained 5 trainers from Ethiopia. In Stage 2, Fudan team supervised and evaluated the 1st stage Ethiopia trainers to train their peers becoming the trainers in Fudan University. In Stage 3, Fudan team evaluated the training program implementation in established Advanced Midwifery Practice Center in Tirunesh Beijing General Hospital. The participatory observational method was used for process evaluation and the Kirkpatrick model was used for effectiveness evaluation. The Ethiopia staff's teaching skills for simulation-based midwifery training were strengthened and their abilities to deal with various complicated obstetric situations were improved by group explanation, questions, rehearsal, and step-by-step interactive teaching (p < .01). The mean score of total mastery degree was 3.48 ± 0.16 by self-assessment and 3.63 ± 0.16 by peer-assessment in stage 2, and 3.27 ± 0.24 by self-assessment and 3.38 ± 0.34 by peer-assessment in stage 3.The GHSP-OP4-V01 Ethiopia Midwife Train-the-Trainer Program has received positive response in Ethiopia by in-depth interview and questionnaire survey. This study demonstrated that the simulation-based training is an effective approach for midwifery Train-the-Trainer program in Ethiopia.
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The Influence of Culture on Teamwork and Communication in a Simulation-Based Resuscitation Training at a Community Hospital in Honduras. ACTA ACUST UNITED AC 2018; 13:363-370. [DOI: 10.1097/sih.0000000000000323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mola GDL, Unger HW. Strategies to reduce and maintain low perinatal mortality in resource-poor settings - Findings from a four-decade observational study of birth records from a large public maternity hospital in Papua New Guinea. Aust N Z J Obstet Gynaecol 2018; 59:394-402. [PMID: 30209806 DOI: 10.1111/ajo.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/13/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND In many low- to middle-income countries (LMIC) assisted vaginal birth rates have fallen, while caesarean section (CS) rates have increased, with potentially deleterious consequences for maternal and perinatal mortality. AIMS To review birth mode and perinatal mortality in a large LMIC hospital with strict labour management protocols and expertise in vacuum extraction. MATERIALS AND METHODS We conducted a retrospective observational study at Port Moresby General Hospital in Papua New Guinea. Birth registers from 1977 to 2015 (39 years) were reviewed. Overall and modified (fresh stillbirths and early neonatal deaths ≥500 g) perinatal mortality rates (PMRs) were calculated by birthweight/birth mode. RESULTS There were 365 056 births (5215 in 1977; 14 927 in 2015), of which 14 179 (3.9%) were vacuum extractions, 609 (0.2%) forceps births and 14 747 (4.4%) CS (increase from 2% to 5%). The failure rate of vacuum extraction was 2.5% (range 0.5-5.4%). Symphysiotomy was employed for 184 births. From 1989 to 2015, the modified mean PMR for babies ≥2500 g was 8.1/1000 births (range 5.6-12.1; 6.9 in 2015), 9.1/1000 for babies ≥1500 g (7.3-14.8; 9.1 in 2015) and 7.5/1000 (0-21.7; 9.0 in 2015) for vacuum extractions (98% were ≥2500 g). The overall PMR for these years was 29.7/1000 births. CONCLUSIONS In an LMIC with rapidly increasing birth numbers a comparatively low PMR can be achieved while maintaining low CS rates. This may be in part accomplished through strict use of second-stage protocols, perinatal audit, and supportive training that promotes judicious and proficient use of vacuum extraction and CS.
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Affiliation(s)
- Glen D L Mola
- Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.,Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Holger W Unger
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Australia.,Department of Obstetrics and Gynaecology, Victoria Hospital, Kirkcaldy, UK
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Kumar A, Wallace EM, Smith C, Nestel D. Effect of an in-situ simulation workshop on home birth practice in Australia. Women Birth 2018; 32:346-355. [PMID: 30220576 DOI: 10.1016/j.wombi.2018.08.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/18/2022]
Abstract
PROBLEM Interprofessional training programs for obstetric emergencies have been introduced for up-skilling birth unit staff in hospitals but not frequently used in training midwives and paramedicine staff for home birth emergency. BACKGROUND Practical Obstetric Multiprofessional Training (PROMPT) has previously been described in the home birth setting using in-situ simulation training of home births for midwifery and paramedicine staff. AIM The aim of this study was to evaluate the benefit of the home birth simulation in clinical practice and to explore how the simulation program prepared the midwives for a birth-related emergency in a publicly funded home birth program. METHODS Midwives conducting home births, the midwifery educator and the simulated woman in labour (n=9) attended an interview that explored how the midwives' learning through simulation affected their home birth clinical practice. The simulated woman and the facilitator who conducted the simulation for more than six years were also interviewed to comment on the observed change in performance in simulation. The interview transcripts were thematically analysed. FINDINGS The themes that were identified and agreed upon, were applying learning to clinical practice, learning in teams, valuing realism, facilitating simulation based education and managing variation. DISCUSSION In-situ nature of simulation with home birth midwives and paramedical staff facilitated learning transfer and team-based approach to practice. The careful simulation design provided a breadth of experience in emergencies. CONCLUSION Applying learning to prepare for clinical emergency situations changed the midwives' approach in managing home births. This provided evidence for a change in behaviour (Level 3 Kirkpatrick's framework) and transfer of learning, leading to changed protocols (Level 4a Kirkpatrick's framework).
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Affiliation(s)
- Arunaz Kumar
- Monash Women's Services, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia.
| | - Euan M Wallace
- Monash Women's Services, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
| | - Cathy Smith
- Monash Women's Services, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia; School of Rural Health, Monash University, Victoria, Australia
| | - Debra Nestel
- School of Rural Health, Monash University, Victoria, Australia
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Huda TM, Hayes A, Dibley MJ. Examining horizontal inequity and social determinants of inequality in facility delivery services in three South Asian countries. J Glob Health 2018; 8:010416. [PMID: 29977529 PMCID: PMC6008508 DOI: 10.7189/jogh.08.010416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The utilization of maternal health care services has increased in many developing countries, but persistent wealth-related inequalities in use of maternal services remained an important public health issue. The paper examined the horizontal inequities and identified the key social determinants that can potentially explain such wealth-related inequalities in use of facility delivery services. Methods The countries studied are Bangladesh, Pakistan and Nepal. We used horizontal inequity index to measure the horizontal inequity and decomposition of concentration index method to assess the contribution of different social determinants towards the wealth-related inequality. We have used household and women data from demographic and health surveys of Bangladesh (BDHS 2014), Pakistan (PDHS 2012-13) and Nepal (NDHS 2010-11). Results All three countries showed pro-rich inequality in use of facility delivery services (Observed Concentration Index: Bangladesh = 0.235; Pakistan = 0.141; Nepal = 0.263). The study showed if the utilization were solely based on need factors there would have been little disparity between the rich and the poor (Need expected Concentration Index: Bangladesh = 0.004; Pakistan = 0.004; Nepal = 0.008). The use of facility delivery remained pro-rich in all three countries after taking the need factors into account (Horizontal inequity Index: Bangladesh = 0.231; Pakistan = 0.137; Nepal = 0.254). The decomposition analysis revealed that facility delivery is driven mostly by the social determinants of health rather than the individual health risk. Household socioeconomic condition, parental education, place of residence and parity emerged as the most important factors. Conclusions Our study reiterates the importance of addressing social determinants of health in tackling wealth-related inequalities in use of facility delivery services. Health policy makers should acknowledge the importance of social determinants in determining individual health-seeking behaviour and accordingly set their strategies to improve access to facility delivery.
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Affiliation(s)
- Tanvir M Huda
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Alison Hayes
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Michael J Dibley
- Sydney School of Public Health, University of Sydney, Sydney, Australia
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Gomez PP, Nelson AR, Asiedu A, Addo E, Agbodza D, Allen C, Appiagyei M, Bannerman C, Darko P, Duodu J, Effah F, Tappis H. Accelerating newborn survival in Ghana through a low-dose, high-frequency health worker training approach: a cluster randomized trial. BMC Pregnancy Childbirth 2018; 18:72. [PMID: 29566659 PMCID: PMC5863807 DOI: 10.1186/s12884-018-1705-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Newborn deaths comprise nearly half of under-5 deaths in Ghana, despite the fact that skilled birth attendants (SBAs) are present at 68% of births, which implies that evidence-based care during labor, birth and the immediate postnatal period may be deficient. We assessed the effect of a low-dose, high-frequency (LDHF) training approach on long-term evidence-based skill retention among SBAs and impact on adverse birth outcomes. METHODS From 2014 to 2017, we conducted a cluster-randomized trial in 40 hospitals in Ghana. Eligible hospitals were stratified by region and randomly assigned to one of four implementation waves. We assessed the relative risks (RRs) of institutional intrapartum stillbirths and 24-h newborn mortality in months 1-6 and 7-12 of implementation as compared to the historical control period, and in post-intervention facilities compared to pre-intervention facilities during the same period. All SBAs providing labor and delivery care were invited to enroll; their knowledge and skills were assessed pre- and post-training, and 1 year later. RESULTS Adjusting for region and health facility type, the RR of 24-h newborn mortality in the 40 enrolled hospitals was 0·41 (95% CI 0·32-0·51; p < 0.001) in months 1-6 and 0·30 (95% CI 0·21-0·43; p < 0·001) in months 7-12 compared to baseline. The adjusted RR of intrapartum stillbirth was 0·64 (95% CI 0·53-0·77; p < 0·001) in months 1-6 and 0·48 (95% CI 0·36-0·63; p < 0·001) in months 7-12 compared to baseline. Four hundred three SBAs consented and enrolled. After 1 year, 200 SBAs assessed had 28% (95% CI 25-32; p < 0·001) and 31% (95% CI 27-36; p < 0·001) higher scores than baseline on low-dose 1 and 2 content skills, respectively. CONCLUSIONS This training approach results in a sustained decrease in facility-based newborn mortality and intrapartum stillbirths, and retained knowledge and skills among SBAs after a year. We recommend use of this approach for future maternal and newborn health in-service training and programs. TRIAL REGISTRATION Retrospectively registered on 25 September 2017 at Clinical Trials, identifier NCT03290924 .
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Affiliation(s)
| | - Allyson R. Nelson
- Jhpiego/Liberia, UN Drive, OPP Rock Compound, Mamba Point, Monrovia, Liberia
| | - Amos Asiedu
- Jhpiego Ghana, 14 Ollenu Street, East Legon, Accra, Ghana
| | - Etta Addo
- Jhpiego Ghana, 14 Ollenu Street, East Legon, Accra, Ghana
| | - Dora Agbodza
- Jhpiego Ghana, 14 Ollenu Street, East Legon, Accra, Ghana
| | - Chantelle Allen
- Jhpiego/Baltimore, 1615 Thames Street, Baltimore, MD 21232 USA
| | | | | | - Patience Darko
- Jhpiego Ghana, 14 Ollenu Street, East Legon, Accra, Ghana
| | - Julia Duodu
- Jhpiego Ghana, 14 Ollenu Street, East Legon, Accra, Ghana
| | - Fred Effah
- Jhpiego Ghana, 14 Ollenu Street, East Legon, Accra, Ghana
| | - Hannah Tappis
- Jhpiego/Baltimore, 1615 Thames Street, Baltimore, MD 21232 USA
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