Jhpiego/Baltimore, 1615 Thames Street, Baltimore, MD, 21232, USA.
Jhpiego/Liberia, UN Drive, OPP Rock Compound, Mamba Point, Monrovia, Liberia.
BMC Pregnancy Childbirth. 2018 Mar 22;18(1):72. doi: 10.1186/s12884-018-1705-5.
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.
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.
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.
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.
Retrospectively registered on 25 September 2017 at Clinical Trials, identifier NCT03290924 .
在加纳，新生儿死亡占 5 岁以下儿童死亡的近一半，尽管有 68%的分娩由熟练的接生员（SBAs）进行，这意味着分娩、分娩和产后即刻期间可能缺乏循证护理。我们评估了低剂量、高频（LDHF）培训方法对 SBAs 长期循证技能保留的影响及其对不良分娩结局的影响。
2014 年至 2017 年，我们在加纳的 40 家医院进行了一项整群随机试验。符合条件的医院按地区分层，并随机分为四个实施波之一。我们评估了实施后 1-6 个月和 7-12 个月与历史对照期相比，以及实施后设施与同一时期实施前设施相比，机构内分娩时死产和 24 小时新生儿死亡率的相对风险（RR）。所有提供分娩和分娩护理的 SBAs 均被邀请参加；在培训前后和 1 年后评估他们的知识和技能。
调整地区和医疗机构类型后，40 家参与医院的 24 小时新生儿死亡率在 1-6 个月时为 0.41（95%CI 0.32-0.51；p<0.001），在 7-12 个月时为 0.30（95%CI 0.21-0.43；p<0.001）与基线相比。分娩时死产的调整 RR 在 1-6 个月时为 0.64（95%CI 0.53-0.77；p<0.001），在 7-12 个月时为 0.48（95%CI 0.36-0.63；p<0.001）与基线相比。共有 403 名 SBAs 同意并参加了这项研究。1 年后，评估了 200 名 SBAs，其中分别有 28%（95%CI 25-32；p<0.001）和 31%（95%CI 27-36；p<0.001）的 SBAs 在低剂量 1 和 2 内容技能方面的得分高于基线。
这种培训方法可导致医疗机构中新生儿死亡率和分娩时死产率持续下降，并在 1 年后保留 SBAs 的知识和技能。我们建议在未来的孕产妇和新生儿卫生在职培训和项目中使用这种方法。
于 2017 年 9 月 25 日在临床试验（标识符：NCT03290924）进行了回顾性注册。
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