Implementation of the Alliance for Innovation on Maternal Health Program to Reduce Maternal Mortality in Malawi
| Autor: | Olivia H Chang, Heather Lytle, Henry Phiri, Joseph Sclafani, Barbara Levy, Rachel Pope, Thomas M. Gellhaus, Carla Eckhardt |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Malawi medicine.medical_specialty Maternal Health Psychological intervention law.invention Young Adult 03 medical and health sciences Patient safety 0302 clinical medicine Condom law Humans Medicine Prospective Studies 030212 general & internal medicine Safety culture Program Development Young adult Prospective cohort study Developing Countries 030219 obstetrics & reproductive medicine business.industry Postpartum Hemorrhage Balloon catheter Obstetrics and Gynecology medicine.disease Organizational Culture Obstetrics Uterine atony Maternal Mortality Emergency medicine Female Patient Safety business |
| Zdroj: | Obstetrics & Gynecology. 133:507-514 |
| ISSN: | 0029-7844 |
| Popis: | Objective To evaluate maternal mortality and changes in the culture of safety before and after the implementation of the Alliance for Innovation on Maternal Health (AIM) Malawi program. Methods This was a prospective cohort study at a central hospital and a district health center in Malawi from March 2016 to November 2017. The AIM Malawi program included classroom didactics on obstetric hemorrhage, teamwork protocols, skills laboratory activities, and simulation training. The time periods of comparison were preintervention, education period, and postintervention. Hospital birth paper records were used to collect data on patient demographics and obstetric and neonatal information. The Hospital Survey of Patient Safety was used to measure the culture of safety before and after the program. Results We trained 128 participants. In the postintervention period, 16 procedural interventions were performed to manage postpartum hemorrhage, including B-lynch sutures (n=7), condom balloon catheter (n=5), nonpneumatic antishock garment (n=3), and uterine artery ligation (n=1). There was a significant increase in the use of B-lynch sutures for the management of uterine atony in the postintervention compared with preintervention period (P=.014). In the postintervention period, the rate of maternal mortality from obstetric hemorrhage decreased significantly from 1.2% to 0.2% (P=.02), a relative decrease of 82.1% from the preintervention rate. Hospital safety culture scores improved significantly from baseline in four out of five domains after the AIM Malawi training. Conclusion After implementation of the AIM Malawi program, we found an increased use of postpartum hemorrhage procedural interventions, a decreased rate of maternal mortality and an increase in Hospital Survey of Patient Safety composite safety scores. The AIM Malawi program may be an effective framework for adaptation to improve maternal mortality in a low-resource setting. |
| Databáze: | OpenAIRE |
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