Saving Lives at Birth in Uganda: Building and Sustaining Capacity of Frontline Health Workers - A Program Evaluation

Saving Lives at Birth in Uganda: Building and Sustaining Capacity of Frontline Health Workers - A Program Evaluation

Patrocinadores

Patrocinador principal: Jhpiego

Colaborador: United States Agency for International Development (USAID)

Fuente Jhpiego
Resumen breve

The study aims are to evaluate the impact of supportive follow-up strategies for a novel twinned training and capacity-sustaining program among frontline health workers (providers) attending facility-based births in remote and district level health facilities in Uganda. The program is designed to improve provider competencies, provider performance and health outcomes among women giving birth and newborns.

Descripción detallada

This study will take place in Uganda at Health Centers (level II, III and IV) and District Hospitals, to reach 'frontline' health providers who attend births. This study will take place in districts meeting study criteria in two regions to demonstrate ability to implement in different geographic settings and potential for scale up. It is a quasi-experimental design with three study arms/groups that receive different levels or intensities and modalities of the program intervention.

Briefly, the same simulator-based training will be provided in all three study arms. After the training, a simulator will be left in the health facility, and providers will be encouraged to practice with it regularly. In two of the study arms, specific health workers will be recruited to support the intervention by encouraging their colleagues to practice with the simulator. In one study arm, the practice will be further reinforced through mobile phone-based support. Following is a more detailed description of each of the three components.

Component 1 (Training): Training is composed of two separate training interventions. First, in each study facility, Ugandan master trainers (district trainers) will conduct a single day, simulator-driven training on PPH prevention and treatment; all providers who attend births will be invited to participate. Eight weeks later, in each facility, the same trainers will conduct a one-day, simulator-driven training for prevention and management of asphyxia in the newborn. After each one-day training, simulators will be left at the facility for practice with a corresponding practice schedule.

Component 2 (Peer-led Practice Sessions): On the day the first training (for PPH), 2 birth attendants at the facility will be selected to serve as clinical mentors (CM). The CMs will be trained to encourage their coworkers to participate in 15-minute practice sessions each week for 8 weeks, in which they will use the simulators to practice the skills learned in the one-day training. After the newborn asphyxia training occurs, these same CMs will be trained to support a similar practice schedule for the following 12 weeks - 8 weeks for newborn asphyxia practice and 4 weeks for combined PPH and asphyxia skills practice.

Component 3 (Mobile phone-based support): CMs will be connected to the district trainer via mobile phone for weekly phone calls during the practice periods to provide reminders and support for practice.

Estado general Completed
Fecha de inicio November 14, 2014
Fecha de Terminación December 31, 2016
Fecha de finalización primaria December 31, 2016
Fase N/A
Tipo de estudio Interventional
Resultado primario
Medida Periodo de tiempo
Difference in differences: change in use of oxytocin for prevention of postpartum hemorrhage Baseline, Midline (6 months), Endline (12 months)
Resultado secundario
Medida Periodo de tiempo
Change in provider performance on simulator-based assessments Pre-test (before training)- post-test (immediately after training) - midline (6 months)
Difference in differences: change in care of the mother composite score Baseline (before training), Midline (6 months), Endline (12 months)
Difference in differences: change care of the newborn composite score Baseline (before training), Midline (6 months), Endline (12 months)
Inscripción 3440
Condición
Intervención

Tipo de intervención: Other

Nombre de intervención: Helping Mothers Survive - Bleeding After Birth training

Descripción: One-day training in postpartum hemorrhage prevention and treatment; this includes instruction to provide oxytocin within one minute of birth to prevent postpartum hemorrhage.

Otro nombre: HMS BAB

Tipo de intervención: Other

Nombre de intervención: Helping Babies Breathe

Descripción: One-day training in neonatal asphyxia management; this includes routine care for the newborn, such as drying and stimulation immediately after birth, and resuscitation of asphyxiated newborns using a bag & mask device.

Otro nombre: HBB

Tipo de intervención: Behavioral

Nombre de intervención: Mentor

Descripción: A birth attendant in the facility is designated as a clinical mentor and encouraged to lead simulator-based practice sessions in the facility after training day.

Otro nombre: CM

Tipo de intervención: Behavioral

Nombre de intervención: Phone

Descripción: District trainers telephone clinical mentors and encourage them to lead practice sessions.

Etiqueta de grupo de brazo: Full - Train/oxy&miso/ B&M/Mentor/Phone

Tipo de intervención: Drug

Nombre de intervención: oxytocin and misoprostol

Descripción: This study did not provide uterotonic drugs except in the case of stock out where locally purchased oxytocin and misoprostol were provided only as back up.

Otro nombre: oxy&miso

Tipo de intervención: Device

Nombre de intervención: Newborn bag and mask

Descripción: All facilities were supplied with at least 1 bag and mask for newborn resuscitation. This bag and mask was used for training, practice, and clinical care

Otro nombre: B&M

Elegibilidad

Criterios:

Inclusion Criteria:

- For Providers: Health providers who attend births in participating health facility and consent to be assessed at the time of enrollment and at several points in time over two years.

- For Clinical mentors: being an experienced skilled birth attendant and likely to remain at the facility during the study period

For Women in Labor and Delivery and Newborns: Women in any stage of labor in participating facility who consent to observation of their delivery and care of their newborn (or consent from the next of kin if the woman is incapacitated and not able to provide consent)

Facility In-charges and Stakeholders: Facility in-charges at sampled health facilities; stakeholders identified by Jhpiego senior managers as being influential in maternal and newborn health policy decisions in Uganda.

Exclusion Criteria:

- Providers: has <1 year of experience, and has plans to be transferred to another facility or leave the facility soon

- Other types of participants: none

Género: All

Edad mínima: N/A

Edad máxima: N/A

Voluntarios Saludables: No

Oficial general
Apellido Papel Afiliación
Cherrie Evans, DrPH Principal Investigator Jhpiego
Fecha de verificación

August 2017

Fiesta responsable

Tipo: Sponsor

Tiene acceso ampliado No
Condición Examinar
Número de brazos 3
Grupo de brazo

Etiqueta: Full - Train/oxy&miso/ B&M/Mentor/Phone

Tipo: Experimental

Descripción: Helping Mothers Survive- Bleeding After Birth training and Helping Babies Breathe training done at the facility, simulator present in each facility, oxytocin and misoprostol backfill, newborn bag and mask, designation of Clinical Mentor in each facility to support deliberate practice, phone-based support from district trainer for Clinical Mentor.

Etiqueta: Partial - Train/oxy & miso/ B&M/Mentor

Tipo: Experimental

Descripción: Helping Mothers Survive - Bleeding After Birth training and Helping Babies Breathe training done at the facility, simulator present in each facility, oxytocin and misoprostol backfill, newborn bag and mask, designation of clinical mentor in each facility to support deliberate practice.

Etiqueta: Comparison - Train/oxy & miso/ B&M

Tipo: Active Comparator

Descripción: Helping Mothers Survive - Bleeding After Birth training and Helping Babies Breathe training done at the facility, simulator present in each facility, oxytocin and misoprostol backfill, newborn bag and mask,.

Datos del paciente Undecided
Información de diseño del estudio

Asignación: Randomized

Modelo de intervención: Parallel Assignment

Propósito primario: Health Services Research

Enmascaramiento: None (Open Label)

Fuente: ClinicalTrials.gov