Onsite training of doctors,midwives and nurses in obstetric emergencies,Zimbabwe |
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| Authors: | Joanna F Crofts Teclar Mukuli Bobb T Murove Solwayo Ngwenya Sma Mhlanga Meluleki Dube Elton Sengurayi Cathy Winter Sharon Jordan Sonia Barnfield Heather Wilcox Abi Merriel Sabelo Ndlovu Zedekiah Sibanda Sikangezile Moyo Wedu Ndebele Tim J Draycott Thabani Sibanda |
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| Affiliation: | aSchool of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England.;bMpilo Central Hospital, Bulawayo, Zimbabwe.;cSchool of Clinical & Experimental Medicine, Birmingham Women''s Hospital Foundation Trust, Birmingham, England.;dMorriston Hospital, Swansea, Wales.;eRoyal Glamorgan Hospital, Cardiff, Wales.;fBay of Plenty District Health Board, Whakatane Hospital, Whakatane, New Zealand. |
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| Abstract: | ProblemIn Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths.ApproachWe established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital.Local settingMaternal mortality in Zimbabwe has increased from 555 to 960 per 100 000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff.Relevant changesFollowing an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014.Lessons learntIntroducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required. |
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