Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe

Abstract

ProblemIn Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths.ApproachWe established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital.Local settingMaternal mortality in Zimbabwe has increased from 555 to 960 per 100 000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff.Relevant changesFollowing an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014.Lessons learntIntroducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required.

A meta‐ethnographic synthesis of midwives’ and nurses’ experiences of adverse labour and birth events

“…Many obstetric emergency training programmes such as Practical Obstetric Multi‐Profession Training (PROMPT) and Advanced Life Support in obstetrics (ALSO) emphasise team work and working collaboratively in adverse outcome situations. Communication, leadership, decision‐making and team work are the key to successful outcomes (Crofts et al., , ).…”

A rapid cycle method for local adaptation of an obstetric emergencies training program

“…PRactical Obstetric Multi‐Professional Training (PROMPT) is an established training program that encompasses all of the key components of effective training and is supported by robust evidence of effect in several settings . This training program was commended as a framework for learning in the 2016 national maternity review of National Health Service England .…”

“…In addition, the PROMPT program has been successfully adapted for use in low‐resource settings. For example, a 34% reduction in maternal deaths was reported following the introduction of PROMPT at a single hospital in Zimbabwe …”

“…7,8 PRactical Obstetric Multi-Professional Training (PROMPT) is an established training program that encompasses all of the key components of effective training and is supported by robust evidence of effect in several settings. [13][14][15][16][17][18] This training program was commended as a framework for learning in the 2016 national maternity review of National Health Service England. 19 Implementation of PROMPT at a large UK hospital led to sustained improvements in maternal and neonatal outcomes, 13,14 with similar results reported at sites in both the USA 15 and Australia.…”

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“…A retrospective observational study to assess impact of training on Apgar scores in a tertiary hospital in Bristol found out that there was an association of significant reduction in low 5 -minute Apgar scores with the introduction of obstetric emergencies training courses 10 . Onsite skills training obstetric emergencies such as on neonatal resuscitation, led to improvement outcomes after the training 11 .…”