Abstract
BackgroundMaternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses).Methods/designThis is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation.DiscussionEducation and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will lead to a sustainable improvement in healthcare and workforce development and training.Trial registrationISRCTN63294155
Highlights
Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe
Education and training of non-physician clinicians (NPCs) is a key to improving healthcare for mothers and babies in countries like Malawi
There is evidence to support a different model of service provision in Africa, whereby the relatively scarce resource of medical obstetric specialists are focused to train and support a service mainly provided by healthcare staff other than doctors, i.e. non-physician clinicians (NPCs) such as assistant medical officers, clinical officers, midwives and outreach community health-workers
Summary
Education and training for Non-Physician Clinicians (NPCs) is the key to improving healthcare for mothers and babies in Sub-Saharan Africa where there are few medical doctors. The primary objective of the ETATMBA project is to develop, implement and evaluate a programme of locally-based clinical service improvement including clinical guidelines, structured education, leadership training and workforce development, which will be linked to specialist support; this trial aims to evaluate the impact of ETATMBA in Malawi. Our primary outcomes of maternal and perinatal mortality (within medical facilities) in a country like Malawi are influenced by many factors other than our intervention. Authors’ information JPO (LRCP, MB BS) is the principal investigator for the trial and is Director of Quality Assurance, at Warwick Medical School (UK). PhD) is a Consultant Obstetrician/Gynaecologist and is principal investigator for the trial at College of Medicine, Malawi. DD (PhD) is an Associate Professor (Reader) in the Warwick Medical School Educational Development & Research Team. His research interests are primarily in global health education and educational technology & e-learning in medical education
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
