Predictors of change of health workers' knowledge and skills after the Helping Mothers Survive Bleeding after Birth (HMS BAB) in-facility training in Tanzania.
坦桑尼亚帮助母亲出生后出血 (HMS BAB) 院内培训后卫生工作者知识和技能变化的预测因子。
- 作者列表："Alwy Al-Beity F","Pembe AB","Marrone G","Baker U","Hanson C
BACKGROUND:Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics. METHODS:Nested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics. RESULTS:Of the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training. CONCLUSION:Our study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics.
背景: 我们的研究旨在评估帮助母亲在产后出血后存活对卫生工作者知识和技能的影响，以及这种影响是否因卫生工作者的特征而异。 方法: 嵌套在一项集群随机试验中，为了评估培训对健康结果的影响，我们评估了61家设施的知识和模拟技能的变化。按照本试验的定义，在i) 之前、ii) 培训后立即进行评估，并且iii) 在10个月的随访期间对实施机构的卫生工作者进行评估.我们使用自我管理问卷和客观结构临床检查来评估三种技能: 第三产程的积极管理、保留胎盘的移除和严重产后出血的管理。我们计算了汇总统计数据，并使用配对t检验来评估培训后和10个月随访时知识和技能的变化。进行线性回归以评估评分与卫生工作者特征的相关性。 结果: 在纳入的636名卫生工作者中，分别有606名 (96.7%) 和591名 (91.4%) 完成了知识和技能评估。大多数参与者 (68%) 是助产士。知识得分从77.5% 增加到93%，增加了15个百分点 (95% CI 14.3，16.3，p值 <0.000)，技能得分从95% 增加到46.5，增加了47个百分点 (49.2 CI 0.000，37.5%，p值 <83%)。在10个月的随访中有4.0% 的技能下降。辅助工作人员的下降幅度较高 (-11.8%)，护士助产士的下降幅度最小 (-2.1%)，p值 <0.001。在最后一个月协助分娩少于5次的卫生工作者、从未参加过产后出血在职培训和职业经验> 8年的卫生工作者与培训后立即的平均技能变化较低相关。 结论: 我们的研究支持帮助母亲在产后出血后存活的潜力，以增加所有专业群体对产后出血的知识和技能。辅助人员从培训中受益最大，但在10个月时也显示出更高的技能下降。我们的研究强调了按照卫生工作者的特点来分类知识和技能的重要性。
METHODS::Objective: To investigate whether intact umbilical cord milking (I-UCM) can aggravate infection or result in other undesirable complications in preterm infants with premature prolonged rupture of membranes (PPROM).Methods: Neonates vaginally delivered between 28 and 37 weeks' gestation and complicated by PPROM before birth were randomly divided into two groups according to the cord clamping procedure: I-UCM before clamping and immediate cord clamping (ICC). Various parameters of the study participants were compared between the two groups.Results: Of 102 preterm infants, 48 and 54 were randomly allocated to the I-UCM and ICC groups, respectively. There were no significant differences between the two groups regarding hematological parameters (platelet count, white blood count, neutrophil ratio, and C-reactive protein) or neonatal outcomes (probable or certain neonatal infection, respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage) (p > .05). However, preterm neonates in the I-UCM group had higher serum hemoglobin and hematocrit levels (p < .05) and received fewer blood transfusions (p < .05) than those in the ICC group.Conclusion: Milking the umbilical cord to a preterm neonate with PPROM will not aggravate neonatal infection or result in other undesirable complications. This simple procedure will improve hemoglobin values and hematocrit levels and may lessen the need for transfusion during the neonatal period.
METHODS::Background: The mannose-binding lectin (MBL2) and nitric oxide synthase 3 (NOS3) genes are associated with the immune response against inflammatory processes, have been reported as possibly related with premature birth. Until now, most of the researches regarding the genetic influence of prematurity have revealed limited results because only investigating the child or the mothers' genotypes, thus not exploring the possible effects of interactions between these genotypes or the interactions with environmental factors related to the duration of pregnancy.Objective: We performed a replica study investigating the influence of single nucleotide polymorphisms (SNPs) in MBL2 and NOS3 genes on premature birth, also considering socioeconomic, demographic, and gestational factors.Materials and methods: We conducted a case-control study with 189 mother-infant dyads, with 104 spontaneous preterm births and 85 term births from Recife, Brazil. We used peripheral blood samples and umbilical cord samples to extract DNA. Functional SNPs at exon 1 and promoter region of MBL2 and NOS3 RS1799983 SNP were genotyped using direct sequencing and fluorescent allelic specific TaqMan® assays respectively. Data were analyzed using the Statistical Package for the Social Sciences (SPSS®) program with bivariate association and logistic multivariate regression tests.Results: We observed a prevalence of MBL2 wild-type genotype in the mother-infant dyad of the preterm group and polymorphic genotype in the mother-infant dyad of term birth. The haplotype LYA predominated in our sample, being more frequent in the preterm group, while the haplotype LYB, correlated with lower levels of MBL protein, was more frequent in the term birth group. About NOS3 RS1799983 SNP, the G/G genotype was more frequent throughout the sample. The heterozygous genotype predominated among women from the preterm group, showed a borderline difference between the groups. When MBL2 genotypes of the mother and son were analyzed together, codon 54 of MBL2 remained associated with prematurity. When the variables with p value lower than .20 in the bivariate analysis were analyzed by logistic regression, the low weight of the pregnant woman in relation to the gestational age, the occurrence of preterm premature rupture of membranes, urinary tract infection during birth and maternal history of other premature births were risk factors to prematurity. On the other hand, the presence of B allele at codon 54 of maternal MBL2 was a protective factor for the occurrence of spontaneous premature birth. In contrast, a borderline association was established between the maternal genetic variation within NOS3 gene and the outcome studied.Conclusions: Our study, limited by the small number of patients enrolled, indicates that MBL2 and NOS3 functional SNPs are associated with the occurrence of spontaneous prematurity and the regulation of the maternal inflammatory response. Despite these results are in agreement with previously reports, our findings do not replicate the ones reported in a large genome-wide association study performed on quite high number of subjects. Thus, we can conclude that MBL2 and NOS3 functional SNPs are plausible candidate risk factors just in few preterm birth cases, and consequently they cannot be included in the general diagnostic practice.
METHODS::Objective: To compare maternal and neonatal outcomes by forceps vaginal delivery versus cesarean delivery during the second stage of labor.Methods: We conducted a retrospective cohort study in a large tertiary maternity center in Shanghai, China through 2007-2016. A total of 7046 women carrying a singleton term nonanomalous fetus with vertex presentation who underwent forceps vaginal delivery, or cesarean delivery from a low station in the second stage of labor were included.Results: Of the 7046 women, 6265 underwent forceps and 781 underwent second stage cesarean delivery. Forceps were associated with lower frequency of maternal infection (2.2 versus 4.7%), but higher incidence of mild postpartum hemorrhage (PPH) (4.3 versus 0.6%). When the procedures were performed for fetal indication, forceps were associated with lower frequency of the composite of perinatal mortality and/or hypoxic ischemic encephalopathy (HIE) (0.5 versus 1.9%; adjusted odds ratio (aOR), 0.24; 95% CI: 0.08-0.75), and also shorter decision to delivery interval (12.3 ± 3.5 versus 19.1 ± 5.0 min). The neonatal infection rate was higher in the forceps group (3.9 versus 2.0%). There were no differences in other neonatal outcomes including birth trauma.Conclusions: In women who had a need for intervention during the second stage with a station of +2 or below, forceps were associated with a lower frequency of maternal infection but a higher rate of PPH. Deliveries performed for nonreassuring status were accomplished faster by forceps and were associated with a lower frequency of the composite of perinatal mortality and HIE.