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Up-skilling associate clinicians in Malawi in emergency obstetric, neonatal care and clinical leadership : the ETATMBA cluster randomised controlled trial
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Ellard, David R., Chimwaza, Wanangwa, Davies, D. A., Simkiss, Douglas E., Kamwendo, Francis, Mhango, Chisale, Quenby, Siobhan, Kandala, Ngianga-Bakwin and O'Hare, J. Paul (2016) Up-skilling associate clinicians in Malawi in emergency obstetric, neonatal care and clinical leadership : the ETATMBA cluster randomised controlled trial. BMJ Global Health, 1 . e000020. doi:10.1136/bmjgh-2015-000020 ISSN 2059-7908.
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WRAP-up-skilling-associate-clinicians-Malawi-emergency-obstetric-neonatal-care-Ellard-2016.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (2378Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjgh-2015-000020
Abstract
Background: The ETATMBA (Enhancing Training And Technology for Mothers and Babies in Africa) project-trained associate clinicians (ACs/clinical officers) as advanced clinical leaders in emergency obstetric and neonatal care. This trial aimed to evaluate the impact of training on obstetric health outcomes in Malawi.
Method: A cluster randomised controlled trial with 14 districts of Malawi (8 intervention, 6 control) as units of randomisation. Intervention districts housed the 46 ACs who received the training programme. The primary outcome was district (health facility-based) perinatal mortality rates. Secondary outcomes included maternal mortality ratios, neonatal mortality rate, obstetric and birth variables. The study period was 2011–2013. Mortality rates/ratios were examined using an interrupted time series (ITS) to identify trends over time.
Results: The ITS reveals an improving trend in perinatal mortality across both groups, but better in the control group (intervention, effect −3.58, SE 2.65, CI (−9.85 to 2.69), p=0.20; control, effect −17.79, SE 6.83, CI (−33.95 to −1.64), p=0.03). Maternal mortality ratios are seen to have improved in intervention districts while worsening in the control districts (intervention, effect −38.11, SE 50.30, CI (−157.06 to 80.84), p=0.47; control, effect 11.55, SE 87.72, CI (−195.87 to 218.98), p=0.90). There was a 31% drop in neonatal mortality rate in intervention districts while in control districts, the rate rises by 2%. There are no significant differences in the other secondary outcomes.
Conclusions: This is one of the first randomised studies looking at the effect of structured training on health outcomes in this setting. Notwithstanding a number of limitations, this study suggests that up-skilling this cadre is possible, and could impact positively on health outcomes.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RG Gynecology and obstetrics | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Reproductive Health ( - until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Obstetrics -- Malawi, Neonatal intensive care -- Malawi, Maternal health services -- Malawi, Health care teams -- Training of -- Malawi, Medical personnel -- Training of -- Malawi | ||||||
| Journal or Publication Title: | BMJ Global Health | ||||||
| Publisher: | BMJ | ||||||
| ISSN: | 2059-7908 | ||||||
| Official Date: | 7 July 2016 | ||||||
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| Volume: | 1 | ||||||
| Article Number: | e000020 | ||||||
| DOI: | 10.1136/bmjgh-2015-000020 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 24 May 2018 | ||||||
| Date of first compliant Open Access: | 25 May 2018 | ||||||
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