Aims To evaluate the effect on the stillbirth rate at a tertiary institution in a low-resource setting through the development of a multi-disciplinary training programme using local trainers.
Methods Twenty-one senior staff (anaesthetists, midwives, doctors, nurses and educators) completed a three day “training of trainers” course in the multi-disciplinary management of obstetric emergencies and neonatal resuscitation. These trainers then delivered six courses (each over two days) to 138 staff & postgraduate students actively involved in the care of labouring mothers and neonates. The course material was derived from the Ethiopian Federal Ministry of Health, World Health Organisation and Ethiopian Paediatric Society’s guidelines.
Results The stillbirth rate over three months following the completion of the training project was compared with the rate in the three month period preceding the initial “training of trainers” course. The mean stillbirth rate fell from 7.6% (SD 2.1%) to 5.3% (SD 1.1%). However, this reduction was not statistically significant (p = 0.08).
A pre-course and post-course (true/false) test was used to assess the participant’s knowledge. The average test scores increased from 65% (pre-test) to 85% (post-test.)
Anonymysied feedback was collected to review the participants views and acceptablity of using local trainers. 97% of respondents felt they had learnt something new. In addition, most respondents found local trainers to be acceptable and credible.
Conclusion The introduction of multi-disciplinary training in obstetric emergencies and neonatal resuscitation using local trainers brough about objective and subjective improvement in staff knowledge and may have contributed to a reduced stillbirth rate. Furthermore, a ‘train the trainers’ model has provided a potentially sustainable resource in the hospital which should continue to impact maternal and perinatal morbidity and mortality. However, further assesment of the impact is required and improvements in other aspects of the health service (such as regular audit and multi-disciplinary review of cases of mortality) are recommended.
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