Ellard, David R., Shemdoe, Aloisia, Mazuguni, Festo, Mbaruku, Godfrey, Davies, D. A., Kihaile, Paul, Pemba, Senga, Bergström, Staffan, Nyamtema, Angelo, Mohamed, Hamed-Mahfoudh and O'Hare, J. Paul (2016) Can training non-physician clinicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project. BMJ Open, 6 (2). pp. 1-12. e008999. doi:10.1136/bmjopen-2015-008999 ISSN 2044-6055.

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Abstract

Objectives

During late 2010, 36 trainees including 19 assistant medical officers (AMOs) 1 senior clinical officer (CO) and 16 nurse midwives/nurses were recruited from districts across rural Tanzania and invited to join the Enhancing Human Resources and Use of Appropriate Technologies for Maternal and Perinatal Survival in the sub-Saharan Africa (ETATMBA) training programme. The ETATMBA project was training associate clinicians (ACs) as advanced clinical leaders in emergency obstetric care. The trainees returned to health facilities across the country with the hope of being able to apply their new skills and knowledge. The main aim of this study was to explore the impact of the ETATMBA training on health outcomes including maternal and neonatal morbidity and mortality in their facilities. Secondly, to explore the challenges faced in working in these health facilities.

Design

The study is a pre-examination/postexamination of maternal and neonatal health indicators and a survey of health facilities in rural Tanzania. The facilities surveyed were those in which ETATMBA trainees were placed post-training. The maternal and neonatal indicators were collected for 2011 and 2013 and the survey of the facilities was in early 2014.

Results

16 of 17 facilities were surveyed. Maternal deaths show a non-significant downward trend over the 2 years (282–232 cases/100 000 live births). There were no significant differences in maternal, neonatal and birth complication variables across the time-points. The survey of facilities revealed shortages in key areas and some are a serious concern.

Conclusions

This study represents a snapshot of rural health facilities providing maternal and neonatal care in Tanzania. Enhancing knowledge, practical skills, and clinical leadership of ACs may have a positive impact on health outcomes. However, any impact may be confounded by the significant challenges in delivering a service in terms of resources. Thus, training may be beneficial, but it requires an infrastructure that supports it.

Item Type:	Journal Article
Subjects:	R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Neonatal intensive care -- Tanzania, Physicians' assistants -- Training of -- Tanzania
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	12 February 2016
Dates:	Date Event 12 February 2016 Published 22 October 2015 Accepted 5 June 2015 Submitted
Volume:	6
Number:	2
Number of Pages:	12
Page Range:	pp. 1-12
Article Number:	e008999
DOI:	10.1136/bmjopen-2015-008999
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	18 February 2016
Date of first compliant Open Access:	22 February 2016
Funder:	Seventh Framework Programme (European Commission) (FP7)
Grant number:	266290 (FP7)

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