Reducing maternal deaths by skills-and-drills training in managing obstetric emergencies : a before-and-after observational study

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dc.contributor.author Pattinson, Robert Clive
dc.contributor.author Bergh, Anne-Marie
dc.contributor.author Ameh, C.
dc.contributor.author Makin, J.A.
dc.contributor.author Pillay, Y.
dc.contributor.author Van den Broek, N.
dc.contributor.author Moodley, J.
dc.date.accessioned 2019-06-21T08:18:11Z
dc.date.available 2019-06-21T08:18:11Z
dc.date.issued 2019-04
dc.description.abstract BACKGROUND. The institutional maternal mortality ratio (iMMR) in South Africa (SA) is still unacceptably high. A key recommendation from the National Committee on Confidential Enquiries into Maternal Deaths has been to improve the availability and quality of care for women suffering obstetric emergencies. OBJECTIVES. To determine whether there was a change in the number of maternal deaths and in the iMMR over time that could be attributed to the training of >80% of healthcare professionals by means of a specifically designed emergency obstetric care (EmOC) training programme. METHODS. A before-and-after study was conducted in 12 healthcare districts in SA, with the remaining 40 districts serving as a comparison group. Twelve ‘most-in-need’ healthcare districts in SA were selected using a composite scoring system. Multiprofessional skills-and-drills workshops were held off-site using the Essential Steps in Managing Obstetric Emergencies and Emergency Obstetric Simulation Training programme. Eighty percent or more of healthcare professionals providing maternity care in each district were trained between October 2012 and March 2015. Institutional births and maternal deaths were assessed for the period January 2011 - December 2016 and a before-andafter- training comparison was made. The number of maternal deaths and the iMMR were used as outcome measures. RESULTS. A total of 3 237 healthcare professionals were trained at 346 workshops. In all, 1 248 333 live births and 2 212 maternal deaths were identified and reviewed for cause of death as part of the SA confidential enquiries. During the same period there were 5 961 maternal deaths and 5 439 870 live births in the remaining 40 districts. Significant reductions of 29.3% in the number of maternal deaths (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.66 - 0.77) and 17.5% in the number of maternal deaths from direct obstetric causes (RR 0.825, 95% CI 0.73 - 0.93) were recorded. When comparing the percentage change in iMMR for equivalent before-and-after periods, there was a greater reduction in all categories of causes of maternal death in the intervention districts than in the comparison districts. CONCLUSIONS. Implementing a skills-and-drills EmOC training package was associated with a significant reduction in maternal deaths. en_ZA
dc.description.department Obstetrics and Gynaecology en_ZA
dc.description.librarian am2019 en_ZA
dc.description.sponsorship DFID South Africa (contract no. 200295-102) and DFID Making it Happen (UK) (contract no. 202945- 101). en_ZA
dc.description.uri http://www.samj.org.za en_ZA
dc.identifier.citation Pattinson, R.C., Bergh, A.-M., Ameh, C. et al. 2019, 'Reducing maternal deaths by skills-and-drills training in managing obstetric emergencies : a before-and-after observational study', South African Medical Journal, vol. 109, no. 4, pp. 241-249. en_ZA
dc.identifier.issn 0256-9574 (print)
dc.identifier.issn 2078-5135 (online)
dc.identifier.other 10.7196/SAMJ.2019.v109i4.13578
dc.identifier.uri http://hdl.handle.net/2263/70261
dc.language.iso en en_ZA
dc.publisher Health and Medical Publishing Group en_ZA
dc.rights © 2019, South African Medical Association. All rights reserved. This article is licensed under a Creative Commons Attribution-NonCommercial Works License (CC BY-NC 3.0). en_ZA
dc.subject Quality of care en_ZA
dc.subject Women en_ZA
dc.subject South Africa (SA) en_ZA
dc.subject Institutional maternal mortality ratio (iMMR) en_ZA
dc.subject Emergency obstetric care (EmOC) en_ZA
dc.subject Maternal deaths en_ZA
dc.subject Healthcare professionals en_ZA
dc.subject Training en_ZA
dc.title Reducing maternal deaths by skills-and-drills training in managing obstetric emergencies : a before-and-after observational study en_ZA
dc.type Article en_ZA


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