The impact of evidence-based education on a perinatal capacity-building initiative in Macedonia

Abstract

The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the "train the teachers" approach, with concurrent strengthening of the infrastructure and organisational framework.

Newborn Resuscitation Training in Resource-Limited Settings: A Systematic Literature Review

“…Ten (22.2%) of the 45 studies reported a breakdown of scores according to cadre, 26,36,39,40,44,50,53,55,56,74 and 7 (70.0%) of these studies showed that birth attendants from lower cadres (eg, midwives) improved significantly more from pretraining to posttraining than those from higher cadres (eg, physicians). 26,40,42,50,53,56,74 In all 7 of these studies, significant differences in pretraining test performance between different cadres were diminished or completely eliminated upon retesting after training. Similarly, a study from HBB in Tanzania found that nurses outperformed health care providers of both higher and lower training levels on a standardized OSCE.…”

“…36 Nine studies (20%) attempted to correlate performance on either standardized tests or actual behavior in the delivery room with changes in neonatal mortality statistics, and the results were mixed. 18,30,31,37,42,60,62,64,73 Four (44.4%) of these studies documented significant declines in neonatal mortality correlating with improvement in test scores and delivery room behavior, respectively. 30,31,42,60 Five studies (55.6%) reported no improvement in mortality despite improvement in test scores and/or delivery room behavior.…”

“…18,30,31,37,42,60,62,64,73 Four (44.4%) of these studies documented significant declines in neonatal mortality correlating with improvement in test scores and delivery room behavior, respectively. 30,31,42,60 Five studies (55.6%) reported no improvement in mortality despite improvement in test scores and/or delivery room behavior. 18,37,62,64,73 However, 3 of these studies (33.3%) showed a decrease either in newborns classified as stillborn or in asphyxiarelated cause-specific mortality, suggesting the training programs had a positive impact.…”

“…Course content varied as well, ranging from focusing solely on basic newborn resuscitation to including bag-mask ventilation (BMV), while relatively few also included chest compressions, administering medications, and endotracheal intubation. Training courses for birth attendants ranged from a 1-time session lasting 3 hours, 41 to intensive courses lasting 4 months, 42 to selfstudy courses lasting 5 weeks. 43 The articles included in the literature review evaluated birth attendants with all levels of education and training, ranging from traditional birth attendants to physicians ( Table 1).…”

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…415 Recent data from a perinatal intervention trial in Macedonia indicate that it may be possible to reduce perinatal and neonatal mortality at the national scale through a concerted perinatal education and health worker-training program within the health system setting. 416 Similarly, the introduction of a structured primary care program in Bolivia, 417 coupled with maternal care, led to a dramatic reduction in infant and young child mortality. In 1992-1993, the annual rates of mortality of children Ͻ5 years old were 205.5 per 1000 and 98.5 per 1000 in the comparison and intervention areas, respectively.…”