Abstract
Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick’s framework for assessment of education effectiveness included: qualitative data on participants’ reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.
Highlights
Skilled attendance at birth providing quality emergency obstetric and newborn care is an essential element for reducing the high burden of maternal and neonatal morbidity and mortality in resource-limited settings (RLS)[1,2].A number of practical skills or “hands-on” short course courses are aimed at improving emergency obstetric care (EmOC)[3]
Wang Pha clinic where 19 participants came from three border clinics (Wang Pha, Maw Ker MRML Mae Ra Mu Wang (Thai) and Mae Tao WPA Wang Pa (Clinic) in Mae Sot)
Subsequent and Basic Life Support in Obstetrics (BLSO) courses From 2008 to 2020, 561 health workers participated in courses conducted at Shoklo Malaria Research Unit (SMRU) and Mae Tao Clinic (MTC): 355 in and 206 in BLSO (Figure 2)
Summary
Skilled attendance at birth providing quality emergency obstetric and newborn care is an essential element for reducing the high burden of maternal and neonatal morbidity and mortality in resource-limited settings (RLS)[1,2].A number of practical skills or “hands-on” short course courses are aimed at improving emergency obstetric care (EmOC)[3]. Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial This manuscript evaluates Advanced Life Support in Obstetrics () and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Kirkpatrick’s framework for assessment of education effectiveness included: qualitative data on participants’ reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of and BLSO.
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