Abstract
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before–after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
Highlights
Reducing maternal and neonatal mortality and morbidity globally remains a priority for the health and development agenda, in the Sustainable Development Goals (World Health Organization, 2015)
We developed a four-level framework to summarize data for the effectiveness of training with regard to: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of emergency obstetric care (EmOC) and health outcomes
Excluding the systematic reviews identified, 50 of the papers included in this review were from low- and middle-income countries (LMIC) and 38 from high income country (HIC)
Summary
Reducing maternal and neonatal mortality and morbidity globally remains a priority for the health and development agenda, in the Sustainable Development Goals (World Health Organization, 2015). Most maternal and newborn deaths and stillbirths occur during or immediately after labour and childbirth. The minimum care package required during pregnancy and childbirth for the management of potentially life-threatening complications is referred to as emergency obstetric care (EmOC) (World Health Organization, 2009). The components (or signal functions) of this care package were agreed by the global partners in 1997 (World Health Organization, 2009). The EmOC care package addresses the main causes of maternal death, stillbirth and early neonatal death, including obstetric haemorrhage, (pre-)eclampsia, sepsis, complications of obstructed labour, complications of miscarriage or abortion
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