The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa ETATReportar como inadecuado




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BMC Pregnancy and Childbirth

, 12:116

Pregnancy and childbirth in low and middle income countries

Abstract

BackgroundMaternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians NPCs such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues other NPCs, midwives, nurses.

Methods-designThis is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi one large district was divided into two giving an overall total of 15. Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme the intervention. Primary outcome will be maternal and perinatal defined as until discharge from health facility mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project 3–4 years and comparisons made. In addition a process evaluation using both quantitative and qualitative e.g. interviews will be undertaken to evaluate the intervention implementation.

DiscussionEducation and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will lead to a sustainable improvement in healthcare and workforce development and training.

Trial registrationISRCTN63294155

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Autor: David Ellard - Doug Simkiss - Siobhan Quenby - David Davies - Ngianga-bakwin Kandala - Francis Kamwendo - Chisale Mhango -

Fuente: https://link.springer.com/







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