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Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality
Ana Garcés1, Elizabeth M McClure, Michael Hambidge
1IMSALUD, Guatemala City, Guatemala. anagarces@imsalud.org
Objectives:
To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes.
Design:
Population-based, prospective, interventional pre-post design study.
Setting:
11 rural clusters in Chimaltenango, Guatemala.
Population:
Health care providers.
Methods:
This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006.
Outcome Measures:
The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g.
Results:
Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57).
Conclusion:
Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability.
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