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Pamungkas DR, O'Sullivan B, McGrail M, Chater B. Tools, frameworks and resources to guide global action on strengthening rural health systems: a mapping review. Health Res Policy Syst 2023; 21:129. [PMID: 38049824 PMCID: PMC10694960 DOI: 10.1186/s12961-023-01078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Inequities of health outcomes persist in rural populations globally. This is strongly associated with there being less health coverage in rural and underserviced areas. Increasing health care coverage in rural area requires rural health system strengthening, which subsequently necessitates having tools to guide action. OBJECTIVE This mapping review aimed to describe the range of tools, frameworks and resources (hereafter called tools) available globally for rural health system capacity building. METHODS This study collected peer-reviewed materials published in 15-year period (2005-2020). A systematic mapping review process identified 149 articles for inclusion, related to 144 tools that had been developed, implemented, and/or evaluated (some tools reported over multiple articles) which were mapped against the World Health Organization's (WHO's) six health system building blocks (agreed as the elements that need to be addressed to strengthen health systems). RESULTS The majority of tools were from high- and middle-income countries (n = 85, 59% and n = 43, 29%, respectively), and only 17 tools (12%) from low-income countries. Most tools related to the health service building block (n = 57, 39%), or workforce (n = 33, 23%). There were a few tools related to information and leadership and governance (n = 8, 5% each). Very few tools related to infrastructure (n = 3, 2%) and financing (n = 4, 3%). This mapping review also provided broad quality appraisal, showing that the majority of the tools had been evaluated or validated, or both (n = 106, 74%). CONCLUSION This mapping review provides evidence that there is a breadth of tools available for health system strengthening globally along with some gaps where no tools were identified for specific health system building blocks. Furthermore, most tools were developed and applied in HIC/MIC and it is important to consider factors that influence their utility in LMIC settings. It may be important to develop new tools related to infrastructure and financing. Tools that have been positively evaluated should be made available to all rural communities, to ensure comprehensive global action on rural health system strengthening.
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Affiliation(s)
- Dewi Retno Pamungkas
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia.
| | - Belinda O'Sullivan
- Toowoomba Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD, Australia.
- Murray Primary Health Network, Bendigo, VIC, Australia.
| | - Matthew McGrail
- Rockhampton Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Rockhampton, QLD, Australia
| | - Bruce Chater
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia
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Michaeli N, De Luca G, Gitau M, Myers J, Ojuka D, Ouma D, Wieland T, Wanjiku G. Evaluation of the World Health Organization-International Committee of the Red Cross Basic Emergency Care course for senior medical students. Int J Emerg Med 2023; 16:29. [PMID: 37085780 PMCID: PMC10120185 DOI: 10.1186/s12245-023-00487-z] [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: 05/31/2022] [Accepted: 02/12/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The Basic Emergency Care: Approach to the acutely ill and injured course was developed to train health care providers to recognize, stabilize, and treat critically ill patients in resource-limited settings. This study evaluates the Basic Emergency Care course as a tool for improving the emergency medicine knowledge and skills of medical students in a lower-middle income country. METHODS This prospective study was conducted with senior medical students at the University of Nairobi School of Medicine in October 2021. Participants' knowledge was assessed with multiple choice pre- and post-course examinations. Pre- and post-course surveys assessed participants' confidence in managing acutely ill and injured patients using a 4-point Likert scale. RESULTS A total of 30 students from the graduating medical school class participated in the study. Post-course examination scores (mean 94.5%, range 80-100%) showed a significant improvement (p < 0.05) compared to pre-course examination scores (mean 82%, range 64-96%). Participants' comfort and confidence in providing emergency care and performing critical emergency skills significantly increased (p < 0.05) between the pre- and post-course surveys. CONCLUSION These findings suggest that the Basic Emergency Care course is effective in providing senior medical students with basic emergency medicine knowledge and increasing their confidence to identify and address life-threatening conditions prior to their intern year.
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Affiliation(s)
- Nichole Michaeli
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St., Providence, RI, 02903, USA.
| | - Giovanna De Luca
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St., Providence, RI, 02903, USA
| | - Mary Gitau
- P.C.E.A. Chogoria Hospital, Chogoria, Kenya
| | - Justin Myers
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Ojuka
- Department of Surgery, University Of Nairobi, College of Health Science, Nairobi, Kenya
| | | | - Travis Wieland
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Grace Wanjiku
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St., Providence, RI, 02903, USA
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Church HR, Murdoch-Eaton D, Sandars J. Under- and post-graduate training to manage the acutely unwell patient: a scoping review. BMC MEDICAL EDUCATION 2023; 23:146. [PMID: 36869334 PMCID: PMC9983517 DOI: 10.1186/s12909-023-04119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Junior doctors are often the first responders to acutely unwell patients and yet frequently report feeling under-prepared to do so. To understand whether this is consequential of how medical students and doctors are trained to manage acutely unwell patients, a scoping review was conducted using a systematic approach. METHODS The review, informed by the Arksey and O'Malley and PRISMA-ScR guidelines, identified educational interventions targeting the management of acutely unwell adults. Seven major literature databases were searched for journal articles published in English from 2005 to 2022, in addition to the Association of Medical Education in Europe (AMEE) conference proceedings from 2014 to 2022. RESULTS Seventy-three articles and abstracts were eligible for the review, the majority of which were from the UK or USA, and demonstrated that educational interventions were more commonly targeted at medical students than qualified doctors. The majority of studies used simulation, but very few integrated complexities of the clinical environment within scenarios such as multidisciplinary working, distraction-handling techniques and other non-technical skills. A wide range of learning objectives pertaining to acute patient management were stated across studies, but few explicitly cited educational theory underpinning their study. CONCLUSIONS The results of this review encourages future educational initiatives to consider enhancing authenticity within simulation to promote transfer of learning to clinical practice, and use educational theory to augment the sharing of educational approaches within the community of clinical education practice. Additionally, increasing the focus on post-graduate learning, building upon undergraduate educational foundations, is essential to promoting lifelong learning within the ever-changing healthcare environment.
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Affiliation(s)
- Helen R Church
- Faculty of Medicine and Health Sciences, University of Nottingham, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK.
| | - Deborah Murdoch-Eaton
- Academic Unit of Medical Education, The University of Sheffield, Sheffield, England, UK
| | - John Sandars
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, England, UK
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Hashmi A, Darakamon MC, Aung KK, Mu M, Misa P, Jittamala P, Chu C, Phyo AP, Turner C, Nosten F, McGready R, Carrara VI. Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border. Front Public Health 2023; 11:1144642. [PMID: 37124770 PMCID: PMC10130587 DOI: 10.3389/fpubh.2023.1144642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Preterm birth is a major public health concern with the largest burden of morbidity and mortality falling within low- and middle-income countries (LMIC). Materials and methods This sequential explanatory mixed methods study was conducted in special care baby units (SCBUs) serving migrants and refugees along the Myanmar-Thailand border. It included a retrospective medical records review, qualitative interviews with mothers receiving care within SCBUs, and focus group discussions with health workers. Changes in neonatal mortality and four clinical outcomes were described. A mix of ethnographic phenomenology and implementation frameworks focused on cultural aspects, the lived experience of participants, and implementation outcomes related to SCBU care. Results From 2008-2017, mortality was reduced by 68% and 53% in very (EGA 28-32 weeks) and moderate (EGA 33-36 weeks) preterm neonates, respectively. Median SCBU stay was longer in very compared to moderate preterm neonates: 35 (IQR 22, 48 days) vs. 10 days (IQR 5, 16). Duration of treatments was also longer in very preterm neonates: nasogastric feeding lasted 82% (IQR 74, 89) vs. 61% (IQR 40, 76) of the stay, and oxygen therapy was used a median of 14 (IQR 7, 27) vs. 2 (IQR 1, 6) days respectively. Nine interviews were conducted with mothers currently receiving care in the SCBU and four focus group discussions with a total of 27 local SCBU staff. Analysis corroborated quantitative analysis of newborn care services in this setting and incorporated pertinent implementation constructs including coverage, acceptability, appropriateness, feasibility, and fidelity. Coverage, acceptability, and appropriateness were often overlapping outcomes of interest highlighting financial issues prior to or while admitted to the SCBU and social issues and support systems adversely impacting SCBU stays. Interview and FGD findings highlight the barriers in this resource-limited setting as they impact the feasibility and fidelity of providing evidence-based SCBU care that often required adaptation to fit the financial and environmental constraints imposed by this setting. Discussion This study provides an in-depth look at the nature of providing preterm neonatal interventions in a SCBU for a vulnerable population in a resource-limited setting. These findings support implementation of basic evidence-based interventions for preterm and newborn care globally, particularly in LMICs.
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Affiliation(s)
- Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
| | - Mu Chae Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mu Mu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Prapatsorn Misa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Verena I. Carrara
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Mamalelala TT, Mokone DJ, Obeng-Adu F. Health-related reasons patients transfer from a clinic or health post to the Emergency Department in a District Hospital in Botswana. Afr J Emerg Med 2022; 12:339-343. [PMID: 35967086 PMCID: PMC9363965 DOI: 10.1016/j.afjem.2022.07.014] [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: 09/27/2021] [Revised: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Rural health clinics in low-resource settings worldwide are usually staffed with health care workers with limited knowledge and skills in managing acute emergencies. The Emergency Centre (EC) at the district hospital or primary hospital serves as an entry point for patients with diverse medical needs from health posts and community clinics. The study described the socio-demographic characteristics, primary diagnosis, and disposition of patients transferred from the clinics and health posts to the district hospital in the Kweneng district. Method This study is a chart audit of the triage sheets and admitting medical records (Botswana Integrated Patient Management System, IPMS) conducted for the period June through to December 2020. Descriptive statistics were used to analyze the quantitative data. Frequencies, percentages, and measures of central tendency were calculated using the software, SPSS version 27. Results A total of 1565 charts were reviewed; 56% (n = 877) were females and 43.5% (n = 681) were males. Half of the patients presenting to the EC ranged from ages 21 to 50, with a mean age of 36.49. The most frequently reported reason for referral was “trauma,” (23.5%, n = 368) whereas the second common reason for referral was abortion-related complications (14.2%, n = 222). The highest admissions were from abortion-related complications (20.2%, n = 169). Most patients’ transfers were from clinics and health posts outside Molepolole (59.4%, n = 930). More than half of the patients (64.2%, n = 537) transferred from outside Molepolole were admitted than discharged from the EC. Discussion Our study has shown significant transfers to a higher facility for emergency care. The higher number of transfers are trauma-related cases, whereas most patients were admitted for abortion-related complications indicating the need for skill-building in trauma care and management of abortions.
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Affiliation(s)
- Tebogo T Mamalelala
- School of Nursing, University of Botswana, Gaborone, Botswana
- Rutgers University School of Nursing, New Brunswick, New Jersey, United States
- Corresponding author.
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McGready R, Rijken MJ, Turner C, Than HH, Tun NW, Min AM, Hla S, Wai NS, Proux K, Min TH, Gilder ME, Sneddon A. A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border. Wellcome Open Res 2021; 6:94. [PMID: 34195384 PMCID: PMC8204190 DOI: 10.12688/wellcomeopenres.16599.2] [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] [Accepted: 06/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick's framework for assessment of education effectiveness included: qualitative data on participants' reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
| | - Marcus J Rijken
- Utrecht University Medical Centre, Utrecht University, Utrecht, Utrecht, 3584 CX, The Netherlands.,Julius Centre Global Health, University Medical Center, Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK.,Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Hla Hla Than
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Sophia Hla
- Reproductive Health, Mae Tao Clinic, Mae Sot, 63110, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Kieran Proux
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Thaw Htway Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University,, Chiang Mai, Chiang Mai, 50200, Thailand
| | - Anne Sneddon
- School of Medicine, Gold Coast campus, Griffith University, Queensland, 4222, Australia
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McGready R, Rijken MJ, Turner C, Than HH, Tun NW, Min AM, Hla S, Wai NS, Proux K, Min TH, Gilder ME, Sneddon A. A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border. Wellcome Open Res 2021; 6:94. [PMID: 34195384 PMCID: PMC8204190 DOI: 10.12688/wellcomeopenres.16599.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 04/30/2024] Open
Abstract
Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick's framework for assessment of education effectiveness included: qualitative data on participants' reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
| | - Marcus J. Rijken
- Utrecht University Medical Centre, Utrecht University, Utrecht, Utrecht, 3584 CX, The Netherlands
- Julius Centre Global Health, University Medical Center, Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Hla Hla Than
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Sophia Hla
- Reproductive Health, Mae Tao Clinic, Mae Sot, 63110, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Kieran Proux
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Thaw Htway Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University,, Chiang Mai, Chiang Mai, 50200, Thailand
| | - Anne Sneddon
- School of Medicine, Gold Coast campus, Griffith University, Queensland, 4222, Australia
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Rybarczyk MM, Ludmer N, Broccoli MC, Kivlehan SM, Niescierenko M, Bisanzo M, Checkett KA, Rouhani SA, Tenner AG, Geduld H, Reynolds T. Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review. Ann Glob Health 2020; 86:60. [PMID: 32587810 PMCID: PMC7304456 DOI: 10.5334/aogh.2681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher- and lower-resource settings. Objective To systematically review the literature to evaluate the composition of EM training programs in low- and middle-income countries (LMICs) developed through partnerships. Methods An electronic search was conducted using four databases for manuscripts on EM training programs - defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care - developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Nicholas Ludmer
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | | | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, US
| | - Mark Bisanzo
- Division of Emergency Medicine, Department of Surgery, University of Vermont, US
| | - Keegan A. Checkett
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | - Shada A. Rouhani
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Andrea G. Tenner
- Department of Emergency Medicine, University of California, San Francisco, US
| | - Heike Geduld
- University of Cape Town/Stellenbosch University, College of Emergency Medicine of South Africa, ZA
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McGready R, Paw MK, Wiladphaingern J, Min AM, Carrara VI, Moore KA, Pukrittayakamee S, Nosten FH. Miscarriage, stillbirth and neonatal mortality in the extreme preterm birth window of gestation in a limited-resource setting on the Thailand-Myanmar border: A population cohort study. Wellcome Open Res 2016; 1:32. [DOI: 10.12688/wellcomeopenres.10352.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 11/20/2022] Open
Abstract
Background: The WHO definition of stillbirth uses 28 weeks’ gestation as the cut-point, but also defines extreme preterm birth as 24 to <28 weeks’ gestation. This presents a problem with the gestational limit of miscarriage, and hence reporting of stillbirth, preterm birth and neonatal death. The objective of this study is to provide a synopsis of the outcome of a population cohort of pregnancies on the Thailand-Myanmar border between 24 to <28 weeks’ gestation. Methods: Records from the Shoklo Malaria Research Unit Antenatal Clinics were reviewed for pregnancy outcomes in the gestational window of 24 to <28 weeks, and each record, including ultrasounds reports, were reviewed to clarify the pregnancy outcome. Pregnancies where there was evidence of fetal demise prior to 24 weeks were classified as miscarriage; those viable at 24 weeks’ gestation and born before 28 weeks were coded as births, and further subdivided into live- and stillbirth. Results: Between 1995 and 2015, in a cohort of 49,931 women, 0.6% (318) of outcomes occurred from 24 to <28 weeks’ gestation, and 35.8% (114) were miscarriages, with confirmatory ultrasound of fetal demise in 45.4% (49/108). Of pregnancies not ending in miscarriage, 37.7% (77/204) were stillborn and of those born alive, neonatal mortality was 98.3% (115/117). One infant survived past the first year of life. Congenital abnormality rate was 12.0% (23/191). Ultrasound was associated with a greater proportion of pregnancy outcome being coded as birth. Conclusion: In this limited-resource setting, pregnancy outcome from 24 to <28 weeks’ gestation included: 0.6% of all outcomes, of which one-third were miscarriages, one-third of births were stillborn and mortality of livebirths approached 100%. In the scale-up to preventable newborns deaths, at least initially, greater benefits will be obtained by focusing on the greater number of viable newborns with a gestation of 28 weeks or more.
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White AL, Min TH, Gross MM, Kajeechiwa L, Thwin MM, Hanboonkunupakarn B, Than HH, Zin TW, Rijken MJ, Hoogenboom G, McGready R. Accelerated Training of Skilled Birth Attendants in a Marginalized Population on the Thai-Myanmar Border: A Multiple Methods Program Evaluation. PLoS One 2016; 11:e0164363. [PMID: 27711144 PMCID: PMC5053505 DOI: 10.1371/journal.pone.0164363] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/24/2016] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate a skilled birth attendant (SBA) training program in a neglected population on the Thai-Myanmar border, we used multiple methods to show that refugee and migrant health workers can be given effective training in their own environment to become SBAs and teachers of SBAs. The loss of SBAs through resettlement to third countries necessitated urgent training of available workers to meet local needs. Methods and Findings All results were obtained from student records of theory grades and clinical log books. Qualitative evaluation of both the SBA and teacher programs was obtained using semi-structured interviews with supervisors and teachers. We also reviewed perinatal indicators over an eight-year period, starting prior to the first training program until after the graduation of the fourth cohort of SBAs. Results Four SBA training programs scheduled between 2009 and 2015 resulted in 79/88 (90%) of students successfully completing a training program of 250 theory hours and 625 supervised clinical hours. All 79 students were able to: achieve pass grades on theory examination (median 80%, range [70–89]); obtain the required clinical experience within twelve months; achieve clinical competence to provide safe care during childbirth. In 2010–2011, five experienced SBAs completed a train-the-trainer (TOT) program and went on to facilitate further training programs. Perinatal indicators within Shoklo Malaria Research Unit (SMRU), such as place of birth, maternal and newborn outcomes, showed no significant differences before and after introduction of training or following graduate deployment in the local maternity units. Confidence, competence and teamwork emerged from qualitative evaluation by senior SBAs working with and supervising students in the clinics. Conclusions We demonstrate that in resource-limited settings or in marginalized populations, it is possible to accelerate training of skilled birth attendants to provide safe maternity care. Education needs to be tailored to local needs to ensure evidence-based care of women and their families.
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Affiliation(s)
- Adrienne Lynne White
- Pregnancy Research Centre, The Royal Women’s Hospital, Melbourne, Australia
- * E-mail:
| | - Thaw Htwe Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Hla Hla Than
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Thet Wai Zin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Marcus J. Rijken
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Julius Global Health and Department of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gabie Hoogenboom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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