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Introduction We examined the degree to which the skills and knowledge of health workers in Ethiopia were retained 18 months after initial maternal and newborn health training and sought to identify factors associated with 18‐month skills assessment performance. Methods A nonexperimental, descriptive design was employed to assess 18‐month skills performance on the topics of Prevent Problems Before Baby Is Born and Prevent Problems After Baby Is Born. Assessment was conducted by project personnel who also received the maternal and newborn health training and additional training to reliably assess health worker performance. Results Among the 732 health workers who participated in maternal and newborn health training in 6 rural districts of the Amhara and Oromia regions of Ethiopia (including pretesting before training and a posttraining posttest), 75 health extension workers (78%) and 234 guide team members (37%) participated in 18‐month posttest. Among health extension workers in both regions, strong knowledge retention was noted in 10 of 14 care steps for Prevent Problems Before Baby Is Born and in 14 of 16 care steps of Prevent Problems After Baby Is Born. Lower knowledge retention was observed among guide team members in the Amhara region. Across regions, health workers scored lowest on steps that involved nonaction (eg, do not give oxytocin). Educational attainment and age were among the few variables found to significantly predict test performance, although participants varied substantially by other sociodemographic characteristics. Discussion Results demonstrated an overall strong retention of knowledge and skills among health extension workers and highlighted the need for improvement among some guide team members. Refresher training and development of strategies to improve knowledge of retention of low‐performing steps were recommended.

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The Home-Based Lifesaving Skills program (HBLSS) is a family- and community-focused, competency-based program that aims to reduce maternal and newborn mortality by increasing access to basic lifesaving measures within the home and community and by decreasing delays in reaching referral facilities where obstetric complications, such as postpartum hemorrhage and newborn asphyxia, can be managed. HBLSS was field tested in rural southern Ethiopia where over 90% of births take place at home with unskilled attendants. The program review assessed 1) the performance of HBLSS-trained guides; 2) management of postpartum hemorrhage and newborn infection by women, family, and birth attendants; 3) exposure of women and families to HBLSS training; and 4) community support. There was improved performance in management of postpartum hemorrhage, a leading cause of maternal death. Findings for management of newborn infection were less compelling. None of the communities had established reliable emergency transportation. Exposure to HBLSS training in the community was estimated at 38%, and there was strong community support. Organizations incorporating HBLSS into proposals focusing on maternal and newborn health during birth and the immediate postpartum period are encouraged to conduct research necessary to establish the evidence base for this promising new approach.

Introduction: Maternal and newborn deaths occur predominantly in low-resource settings. Community-based packages of evidence-based interventions and skilled birth attendance can reduce these deaths. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) used community-level health workers to conduct prenatal Community Maternal and Newborn Health family meetings to build skills and care-seeking behaviors among pregnant women and family caregivers. Methods:Baseline and endline surveys provided data on a random sample of women with a birth in the prior year. An intention-to-treat analysis, plausible net effect calculation, and dose-response analysis examined increases in completeness of care (mean percentage of 17 maternal and newborn health care elements performed) over time and by meeting participation. Regression models assessed the relationship between meeting participation, completeness of care, and use of skilled providers or health extension workers for birth care-controlling for sociodemographic and health service utilization factors.Results: A 151% increase in care completeness occurred from baseline to endline. At endline, women who participated in 2 or more meetings had more complete care than women who participated in fewer than 2 meetings (89% vs 76% of care elements; P Ͻ .001). A positive dose-response relationship existed between the number of meetings attended and greater care completeness (P Ͻ .001). Women with any antenatal care were nearly 3 times more likely to have used a skilled provider or health extension worker for birth care. Women who had additionally attended 2 or more meetings with family members were over 5 times as likely to have used these providers, compared to women without antenatal care and who attended fewer than 2 meetings (odds ratio, 5.19; 95% confidence interval, 2.88-9.36; P Ͻ .001).Discussion: MaNHEP's family meetings complemented routine antenatal care by engaging women and family caregivers in self-care and careseeking, resulting in greater completeness of care and more highly skilled birth care. J Midwifery Womens Health 2014;59:S44-S54 c 2014 by the American College of Nurse-Midwives.Keywords: community-based intervention, Ethiopia, maternal and newborn health, participatory, skilled birth attendance INTRODUCTIONThe global burden of maternal and newborn mortality is borne almost exclusively by low-and middle-income countries.1 Despite progress in the last decade, Millennium Development Goals 4 and 5, which address these issues, are unlikely to be met by the 2015 target in many countries.2 In Ethiopia, a country with one of the world's highest rates of maternal and newborn mortality, the Federal Ministry of Health has undertaken aggressive steps to enact national policies designed to meet the Millennium Development Goals.It is well understood that a package of simple, low-tech practices-such as clean birth practices; neonatal resuscitation; and immediate, exclusive breastfeeding-can dramatically and positively improve newborn survival.3 Evidence establishes th...