Abstract:
Background Training health providers is an important
strategy to improve health. We conducted a clusterrandomised
two-arm trial in Tanzania to assess the effect
of a 1-day competency-based training ‘Helping Mothers
Survive Bleeding after Birth (HMS BAB)’ followed by eight
weekly drills on postpartum haemorrhage (PPH)-related
morbidity and mortality.
Methods Twenty districts in four purposefully selected
regions in Tanzania included 61 facilities. The districts
were randomly allocated using matched pairs to ensure
similarity in terms of district health services in intervention
and comparison districts. In the 10 intervention districts
331 health providers received the HMS BAB training. The
other half continued with standard practices. We used
the WHO’s near miss tool to collect information on severe
morbidity (near misses) of all women admitted to study
facilities. We performed interrupted time series analysis
to estimate differences in the change of near miss per
delivery rate and case fatality rates. We also assessed
implementation of evidence-based preventive and basic
management practices for PPH as secondary outcomes.
Results We included 120 533 facility deliveries, 6503
near misses and 202 maternal deaths in study districts
during study period (November 2014 to January 2017).
A significant reduction of PPH near misses was found
among women who suffered PPH in the intervention
district compared with comparison districts (difference-indifferences
of slopes −5.3, 95% CI −7.8 to −2.7, p<0.001)
from a baseline PPH-related near miss rate of 71% (95%
CI 60% to 80%). There was a significant decrease in
the long-term PPH near miss case fatality (differencein-
differences of slopes −4 to 0) (95% CI −6.5 to −1.5,
p<0.01) in intervention compared with the comparison
districts. The intervention had a positive effect on the
proportion of PPH cases treated with intravenous oxytocin
(difference-in-differences of slopes 5.2, 95% CI 1.4 to 8.9)
(p <0.01).
Conclusion The positive effect of the training intervention
on PPH morbidity and case fatality suggests that the
training addresses important deficits in knowledge and
skills.
