Implementation of the Alliance for Innovation on Maternal Health Program to Reduce Maternal Mortality in Malawi

Abstract

To evaluate maternal mortality and changes in the culture of safety before and after the implementation of the Alliance for Innovation on Maternal Health (AIM) Malawi program. METHODS: This was a prospective cohort study at a central hospital and a district health center in Malawi from March 2016 to November 2017. The AIM Malawi program included classroom didactics on obstetric hemorrhage, teamwork protocols, skills laboratory activities, and simulation training. The time periods of comparison were preintervention, education period, and postintervention. Hospital birth paper records were used to collect data on patient demographics and obstetric and neonatal information. The Hospital Survey of Patient Safety was used to measure the culture of safety before and after the program. RESULTS:We trained 128 participants. In the postintervention period, 16 procedural interventions were performed to manage postpartum hemorrhage, including B-lynch sutures (n57), condom balloon catheter (n55), nonpneumatic antishock garment (n53), and uterine artery ligation (n51). There was a significant increase in the use of B-lynch sutures for the management of uterine atony in the postintervention compared with preintervention period (P5.014). In the postintervention period, the rate of maternal mortality from obstetric hemorrhage decreased significantly from 1.2% to 0.2% (P5.02), a relative decrease of 82.1% from the preintervention rate. Hospital safety culture scores improved significantly from baseline in four out of five domains after the AIM Malawi training.CONCLUSION: After implementation of the AIM Malawi program, we found an increased use of postpartum hemorrhage procedural interventions, a decreased rate of maternal mortality and an increase in Hospital Survey of Patient Safety composite safety scores. The AIM Malawi program may be an effective framework for adaptation to improve maternal mortality in a lowresource setting.

Simulation-Based Training in Emergency Obstetric Care in Sub-Saharan and Central Africa: A Scoping Review

“…Table 1 provides a detailed description of the study characteristics of the 47 included studies. The studies span a diverse array of study designs including eighteen pre-post studies [ 21 22 31 32 33 34 35 36 37 38 23 24 25 26 27 28 29 30 ], seven cluster-randomized controlled trials [ 39 40 41 42 43 44 45 ], five descriptive studies [ 46 47 48 49 50 ], two quasi-experimental studies [ 51 52 ], and one observational study [ 53 ]. Ten studies included both descriptive and pre-post data [ 54 55 56 57 58 59 60 61 62 63 ], and two studies included both descriptive and observational data [ 64 65 ].…”

“…Additionally, simulation-based training programs were increasingly accompanied by other quality improvement collaboratives such as maternal death reviews, supportive supervision visits, mobile mentoring (by phone or SMS), or peer-assistant learning [ 26 39 52 66 79 40 41 42 43 45 47 49 51 ]. Most studies were conducted in Tanzania [ 22 28 71 74 75 78 80 30 34 51 63 64 65 69 70 ], Ghana [ 27 33 41 47 54 60 80 81 ], Kenya [ 45 58 63 72 73 80 ], Uganda [ 42 43 45 49 57 61 ], and Malawi [ 36 63 64 80 ]. The range of involved hospitals spans the whole spectrum from rural health clinics to tertiary teaching hospitals.…”

“…In six studies training was set up uniprofessional [ 25 27 35 41 54 61 ] and in 37 studies interprofessional [ 31 32 45 47 48 49 51 52 55 56 58 60 33 62 63 64 65 70 71 72 73 74 75 34 77 78 81 82 83 84 85 36 37 38 40 43 44 ]. Twenty-seven studies concentrated on technical skills [ 21 22 48 51 52 54 56 62 64 65 69 71 25 72 73 74 78 84 85 86 27 32 34 37 38 42 43 ], one study on non-technical skills [ 35 ], and nineteen on both technical and non-technical skills [ 30 33 63 68 79 80 81 82 …”

“…Table 1 gives an overview of all evaluated levels of Kirkpatrick’s model. Eighteen studies described results on Kirkpatrick level 1 [ 36 44 61 62 63 64 65 75 83 84 47 48 49 54 55 56 58 60 ]. All studies showed positive reactions, and challenges and recommendations were faced in twelve studies ( Table 2 ).…”

“…Twelve studies investigated the effectiveness of training at Kirkpatrick level 3 [ 22 29 70 90 30 36 42 43 49 54 55 58 ]. Seven studies described improvements of skills on the job [ 22 30 36 42 55 71 78 ], and two studies reported on organizational changes in workplace [ 55 58 ]. One study reported no transfer of skills into clinical practice [ 70 ].…”