Background: Philippines has some of the highest NMR (14 per 1000 live births) and MMR (MMR 220 per 100,000 live births) in Asia. Prior studies in limited-resource settings have shown efficacy of simulation-based HBB initiatives in improving education and regional stillbirth rates. The HMS program similarly addresses emergency obstetric care.
Methods: Training courses in HBB/HMS were conducted for N=55 midwives in Davao, Philippines as part of an interventional cohort study. Multiple choice exams and videotaped objective standardized clinical assessments were used to measure knowledge and skills pre and post intervention. Outcome measures were compared pre and post intervention using t-test comparison of means.
Results: Written knowledge tests revealed a 13% relative improvement in post-test scores (p < 0.001). Skill improvement in maternal resuscitation was demonstrated by decrease in average time to administration of uterotonic agent after birth from 95 to 54 seconds (p < 0.001) and in neonatal resuscitation by achievement of successful bag mask ventilation by 45% pre intervention vs. 100% post intervention (p < 0.001).
Discussions: Combined training in neonatal and obstetric management resulted in increased knowledge and skills for midwives in this resource-limited setting. Next steps include assessment of skill decay curves, rate of uptake of best practices, and longitudinal analysis of regional NMR and MMR.
Keywords: Community Health, Curriculum Development/Evaluation, Global Health, Healthcare Workforce, Simulation
Topics: CREOG & APGO Annual Meeting, 2017, Student, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Simulation, Global Health,
Jill Edwardson, M.D., M.P.H., Johns Hopkins University School of Medicine; Nicole Shilkofski, M.D., M.Ed
