Center for Global Health and Development, Boston University, Boston, MA, USA.
BMJ. 2011 Feb 3;342:d346. doi: 10.1136/bmj.d346.
To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare.
Prospective, cluster randomised and controlled effectiveness study.
Lufwanyama, an agrarian, poorly developed district located in the Copperbelt province, Zambia. All births carried out by study birth attendants occurred at mothers' homes, in rural village settings.
127 traditional birth attendants and mothers and their newborns (3559 infants delivered regardless of vital status) from Lufwanyama district.
Using an unblinded design, birth attendants were cluster randomised to intervention or control groups. The intervention had two components: training in a modified version of the neonatal resuscitation protocol, and single dose amoxicillin coupled with facilitated referral of infants to a health centre. Control birth attendants continued their existing standard of care (basic obstetric skills and use of clean delivery kits).
The primary outcome was the proportion of liveborn infants who died by day 28 after birth, with rate ratios statistically adjusted for clustering. Secondary outcomes were mortality at different time points; and comparison of causes of death based on verbal autopsy data.
Among 3497 deliveries with reliable information, mortality at day 28 after birth was 45% lower among liveborn infants delivered by intervention birth attendants than control birth attendants (rate ratio 0.55, 95% confidence interval 0.33 to 0.90). The greatest reductions in mortality were in the first 24 hours after birth: 7.8 deaths per 1000 live births for infants delivered by intervention birth attendants compared with 19.9 per 1000 for infants delivered by control birth attendants (0.40, 0.19 to 0.83). Deaths due to birth asphyxia were reduced by 63% among infants delivered by intervention birth attendants (0.37, 0.17 to 0.81) and by 81% within the first two days after birth (0.19, 0.07 to 0.52). Stillbirths and deaths from serious infection occurred at similar rates in both groups.
Training traditional birth attendants to manage common perinatal conditions significantly reduced neonatal mortality in a rural African setting. This approach has high potential to be applied to similar settings with dispersed rural populations. Trial registration Clinicaltrials.gov NCT00518856.
在一个医疗资源匮乏、获取医疗服务机会有限的贫穷国家，研究培训传统助产妇管理几种常见围产期疾病，能否降低新生儿死亡率。
前瞻性、整群随机对照效果研究。
赞比亚铜带省卢富瓦尼亚马区，为农业地区，欠发达。所有研究助产妇接生的分娩均在产妇家中、农村进行。
127 名传统助产妇及其母亲和新生儿（3559 名不论死活的婴儿），均来自卢富瓦尼亚马区。
采用非盲法设计，将助产妇整群随机分为干预组和对照组。干预有两个组成部分：对新生儿复苏方案进行改良的培训，以及单次阿莫西林剂量加促进将婴儿转至保健中心。对照组助产妇继续采用现有的标准护理（基本产科技能和使用清洁分娩包）。
主要结局是出生后 28 天内活产婴儿的死亡率，死亡率比经统计学调整了集群效应的比值比。次要结局是不同时间点的死亡率；以及根据死因推断数据比较死亡原因。
在 3497 例有可靠信息的分娩中，与对照组助产妇接生的活产婴儿相比，干预组助产妇接生的活产婴儿在出生后 28 天的死亡率低 45%（死亡率比 0.55，95%可信区间 0.33 至 0.90）。出生后 24 小时内死亡率降幅最大：干预组助产妇接生的婴儿每 1000 例活产中有 7.8 例死亡，而对照组助产妇接生的婴儿每 1000 例活产中有 19.9 例死亡（0.40，0.19 至 0.83）。干预组助产妇接生的婴儿中，因分娩窒息导致的死亡减少了 63%（0.37，0.17 至 0.81），出生后头两天内减少了 81%（0.19，0.07 至 0.52）。两组的死产和严重感染导致的死亡发生率相似。
培训传统助产妇管理常见围产期疾病，可显著降低非洲农村地区的新生儿死亡率。这种方法很有潜力适用于农村人口分散的类似环境。
Clinicaltrials.gov NCT00518856。
