Effects of emergency obstetric care training on maternal and perinatal outcomes: a stepped wedge cluster randomised trial in South Africa

van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684, Ameh, Charles ORCID: https://orcid.org/0000-0002-2341-7605, Madaj, Barbara ORCID: https://orcid.org/0000-0002-4073-3191, Makin, Jennifer, White, Sarah ORCID: https://orcid.org/0000-0001-5535-8075, Hemming, Karla, Moodley, J and Pattinson, Robert (2019) 'Effects of emergency obstetric care training on maternal and perinatal outcomes: a stepped wedge cluster randomised trial in South Africa'. BMJ Global Health, Vol 4, Issue 6, e001670.

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Abstract

Introduction
Two-thirds of maternal deaths and 40% of intrapartum-related neonatal deaths are thought to be preventable through emergency obstetric and newborn care (EmOC&NC). The effectiveness of ‘skills and drills’ training of maternity staff in EmOC&NC was evaluated.
Methods
Implementation research using a stepped wedge cluster randomised trial including 127 of 129 healthcare facilities (HCFs) across the 11 districts in South Africa with the highest maternal mortality. The sequence in which all districts received EmOC&NC training was randomised but could not be blinded. The timing of training resulted in 10 districts providing data before and 10 providing data after EmOC&NC training. Primary outcome measures derived for HCFs are as follows: stillbirth rate (SBR), early neonatal death (ENND) rate, institutional maternal mortality ratio (iMMR) and direct obstetric case fatality rate (CFR), number of complications recognised and managed and CFR by complication.
Results
At baseline, median SBR (per 1000 births) and ENND rate (per 1000 live births) were 9 (IQR 0–28) and 0 (IQR 0–9). No significant changes following training in EmOC&NC were detected for any of the stated outcomes: SBR (adjusted incidence rate ratio (aIRR) 0.97, 95% CI 0.91 to 1.05), iMMR (aIRR 1.23, 95% CI 0.80 to 1.90), ENND rate (aIRR 1.04, 95% CI 0.92 to 1.17) and direct obstetric CFR (aIRR 1.15, 95% CI 0.66 to 2.02). The number of women who were recognised to need and received EmOC was significantly increased overall (aIRR 1.14, 95% CI 1.02 to 1.27), for haemorrhage (aIRR 1.31, 95% CI 1.13 to 1.52) and for postpartum sepsis (aIRR 1.86, 95% CI 1.17 to 2.95)
Conclusion
Following EmOC&NC training, healthcare providers are more able to recognise and manage complications at time of birth. This trial did not provide evidence that the intervention was effective in reducing adverse clinical outcomes, but demonstrates randomised evaluations are feasible in implementation research.

Item Type:	Article
Subjects:	WA Public Health > Statistics. Surveys > WA 900 Public health statistics WB Practice of Medicine > WB 105 Emergency medicine. Medical emergencies WQ Obstetrics > WQ 100 General works WQ Obstetrics > WQ 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjgh-2019-001670
Depositing User:	Rachel Dominguez
Date Deposited:	15 Nov 2019 12:21
Last Modified:	03 Sep 2021 13:57
URI:	https://archive.lstmed.ac.uk/id/eprint/13096

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