Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania.
PLoS One. 2020 May 18;15(5):e0232983. doi: 10.1371/journal.pone.0232983. eCollection 2020.
Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics.
Nested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics.
Of the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training.
Our study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics.
我们的研究旨在评估“帮助产妇产后止血”对卫生工作者知识和技能的影响，以及这种影响是否因卫生工作者的特征而有所不同。
在一项评估培训对健康结果影响的集群随机试验中，我们评估了 61 个设施中知识和模拟技能的变化。评估在以下三个时间点进行：i）培训前，ii）培训后即刻，iii）为实施设施的卫生工作者设定的试验定义的 10 个月随访期的亚组。我们使用自我管理问卷和客观结构临床考试来评估三个技能集：第三产程的积极管理、胎盘残留的清除和产后严重出血的管理。我们计算了汇总统计数据，并使用配对 t 检验评估培训后即刻和 10 个月随访时的知识和技能变化。进行线性回归以评估分数与卫生工作者特征的关联。
在 636 名卫生工作者中，606 名（96.7%）和 591 名（91.4%）分别完成了知识和技能评估。大多数参与者（68%）是护士助产士。知识得分从 77.5%增加到 93%（95%置信区间 14.3，16.3，p 值<0.000），技能得分从 37.5%增加到 83%（95%置信区间 46.5，49.2，p 值<0.000），增加了 47 个百分点。在 10 个月的随访中，技能得分下降了 4.0%。辅助人员的下降幅度更高（-11.8%），护士助产士的下降幅度最低（-2.1%），p 值<0.001。在过去一个月中，参与分娩少于 5 次、从未参加过产后出血在职培训且专业经验超过 8 年的卫生工作者，其培训后即刻的平均技能变化较小。
我们的研究支持“帮助产妇产后止血”培训有潜力提高所有专业群体的产后出血知识和技能。辅助人员从培训中获益最多，但在 10 个月时技能下降幅度也最高。我们的研究强调了按卫生工作者特征对知识和技能进行细分的重要性。
