基于能力的（HMS BAB）培训对孕产妇发病率的影响：坦桑尼亚20个地区的一项整群随机试验。
Effect of the competency-based (HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania.
作者信息
Alwy Al-Beity Fadhlun, Pembe Andrea, Hirose Atsumi, Morris Jessica, Leshabari Sebalda, Marrone Gaetano, Hanson Claudia
机构信息
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.
出版信息
BMJ Glob Health. 2019 Mar 7;4(2):e001214. doi: 10.1136/bmjgh-2018-001214. eCollection 2019.
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.
背景
培训医疗服务提供者是改善健康状况的一项重要策略。我们在坦桑尼亚开展了一项整群随机双臂试验，以评估为期1天的基于能力的培训“帮助母亲产后止血（HMS BAB）”以及随后每周进行8次演练对产后出血（PPH）相关发病率和死亡率的影响。
方法
在坦桑尼亚四个经特意挑选的地区中的20个区纳入了61家医疗机构。这些区通过配对随机分配，以确保干预区和对照区在地区卫生服务方面的相似性。在10个干预区，331名医疗服务提供者接受了HMS BAB培训。另一半继续采用标准做法。我们使用世界卫生组织的“险些发生但未发生的事件”工具收集所有入住研究机构的妇女严重发病情况（险些发生但未发生的事件）的信息。我们进行了中断时间序列分析，以估计每次分娩险些发生但未发生的事件发生率和病死率变化的差异。我们还评估了PPH循证预防和基本管理措施的实施情况作为次要结果。
结果
在研究期间（2014年11月至2017年1月），研究区共纳入120533例机构分娩、6503例险些发生但未发生的事件和202例孕产妇死亡。与对照区相比，干预区发生PPH的妇女中PPH险些发生但未发生的事件显著减少（斜率差异 -5.3，95%可信区间 -7.8至 -2.7，p<0.001），基线PPH相关险些发生但未发生的事件发生率为71%（95%可信区间60%至80%）。与对照区相比，干预区长期PPH险些发生但未发生的事件病死率显著下降（斜率差异 -4至0）（95%可信区间 -6.5至 -1.5，p<0.01）。该干预对静脉注射缩宫素治疗的PPH病例比例有积极影响（斜率差异5.2，95%可信区间1.4至8.9）（p<0.01）。
结论
培训干预对PPH发病率和病死率的积极影响表明，该培训解决了知识和技能方面的重要不足。
试验注册号
PACTR201604001582128。
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