Effect of the competency-based
PPH near miss
Tanzania
competency-based training
maternal morbidities and mortalities
near miss
postpartum haemorrhage
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
2019
2019
Historique:
received:
11
10
2018
revised:
05
02
2019
accepted:
10
02
2019
entrez:
19
4
2019
pubmed:
19
4
2019
medline:
19
4
2019
Statut:
epublish
Résumé
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. 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. 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). The positive effect of the training intervention on PPH morbidity and case fatality suggests that the training addresses important deficits in knowledge and skills. PACTR201604001582128.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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
BACKGROUND
PACTR201604001582128.
Identifiants
pubmed: 30997164
doi: 10.1136/bmjgh-2018-001214
pii: bmjgh-2018-001214
pmc: PMC6441296
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e001214Déclaration de conflit d'intérêts
Competing interests: None declared.
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