Ellard, David R., Simkiss, Douglas E., Quenby, Siobhan, Davies, D. A., Kandala, Ngianga-Bakwin, Kamwendo, Francis, Mhango, Chisale and O'Hare, J. Paul (2012) 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 (ETATMBA) project. BMC Pregnancy and Childbirth, Volume 12 (Number 1). p. 116. doi:10.1186/1471-2393-12-116 ISSN 1471-2393.

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Abstract

Background:
Maternal 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/design:
This 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.

Discussion:
Education 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 registration:
ISRCTN63294155

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RG Gynecology and obstetrics
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medical personnel -- Training of -- Malawi, Mothers -- Mortality -- Malawi -- Statistics, Perinatal death -- Malawi -- Statistics
Journal or Publication Title:	BMC Pregnancy and Childbirth
Publisher:	BioMed Central Limited
ISSN:	1471-2393
Official Date:	25 October 2012
Dates:	Date Event 25 October 2012 Published
Volume:	Volume 12
Number:	Number 1
Page Range:	p. 116
DOI:	10.1186/1471-2393-12-116
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	24 December 2015
Date of first compliant Open Access:	24 December 2015
Funder:	Seventh Framework Programme (European Commission) (FP7)

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