Progress
report of “Helping Mothers Deliver – an assessment
of the quality of obstetric care and a prospective study of the impact of
simulation-based training in emergency obstetric care in a resource-limited
rural hospital in Tanzania”.
Introduction
First of all,
I would like to thank you for supporting me and my research project in
Tanzania. Without your financial support it wouldn’t have been possible to
conduct this very relevant research in saving the lives of mothers in Tanzania,
but also worldwide. This report is to give you an overview of the activities that
I have undertaken to reach the pre-defined goals.
To refresh your memory, in summary my research
project is about the evaluation of the simulation-based training “Helping
Mothers Survive - Bleeding After Birth” (HMS-BAB) that will be given in Haydom
Lutheran Hospital (HLH). The evaluation will be based on the four levels of
Kirkpatrick. The first level is reaction: how do people value the
simulation-based training? Participants of the training will be assessed by means
of an evaluation form immediately after the course. The second level is
learning: How do the participants change their knowledge, skills and attitude
after training compared to before training? This will be assessed by a
knowledge and skills test and an attitude questionnaire before, immediately
after and at six months after training. The third level is behaviour: How do
people change their behaviour in daily practice with the newly acquired
knowledge and skills? This will be assessed by prospective observations of all
deliveries that take place in HLH during 6 months before intervention and 6
months after intervention. The last level that will be addressed is the
outcome: How does training affect the outcome of the mother? This will be
assessed by both the prospective observations, but also by the maternal
morbidity and mortality data that is collected in the hospital since November
2009.
Progress of
research
In the past year I have done a literature
review of the available literature concerning maternal morbidity and mortality
on a global scale and simulation based medical education. Furthermore I
attended courses in “Introduction in clinical research and biostatistics for
clinicians” and “Principles of epidemiologic data-analysis”. I visited two
conferences; in February I went to the Africa Regional Meeting on Interventions for Impact in Essential
Obstetric and Newborn Care in Addis Ababa and in June I went to the ICM conference in Durban. Both
were very valuable for connecting with key persons involved with MamaNatalie
and Helping Mother Survive from Lærdal and Jhpiego.
As stated in
the research proposal as you have received it in October last year, I have been
able to continue with the collection of maternal near miss and maternal death cases.
This November we accomplished two years of registration and we will continue at
least another two years. Furthermore I have been preparing data collection
tools with Hege Langli Ersdal and Doris Østergaard for the simulation-based training
with Mama Natalie that is coming up in collaboration.
NIMR clearance
One of the first aims of 2011 was to achieve
IRB clearance from the National Institute for Medical Research (NIMR).
Unfortunately our application got lost twice and I submitted the application
again in November 2011 in person. We have received the research clearance
certificate from NIMR on 29-12-2011.
Field visits
to Tanzania
In 2011 I
completed four field visits to Haydom Lutheran Hospital (HLH).
In February
2011 I assessed the quality of data collection for the maternal near miss and
death registration. I also assessed the data that was being collected regarding
maternal complications by the research assistants in labour ward. We decided
that the data collection tool for registering maternal complication needed
improvement and also the research assistants needed additional training.
In May 2011 I
visited HLH again and introduced the new data collection tool for registering
maternal complications. The research assistants, who have finished secondary
school form 4, were trained in two days on how to fill in the form. I was
assisted by a Tanzanian intern who also translated the forms and an explanation
on how to fill in the form in Swahili. On 25-05-2011 we started with the
baseline data collection regarding maternal complications in labour ward.
My third visit to HLH was in August 2011 that is when I also met
the full board of the Lærdal
Foundation. We had a very valuable day in which we showed the board members
around the hospital and also presented preliminary results and progress of the
research. During that visit I also retrained the research assistants and
assessed the quality of the maternal morbidity and mortality data that was
collected in the previous three months.
During my
last visit to Tanzania in November and December, I resubmitted our proposal to
NIMR, retrained the research assistants, did quality assessment of the maternal
morbidity and mortality data and had several meetings with the hospital
management to create a platform to improve the quality of obstetric care and to
make people aware of the upcoming training of Helping Mothers Survive –
Bleeding After Birth. Especially the last meeting was also used to involve the
health care workers and management in the preparation of the training in an
interactive way.
Challenges
Our first aim was to give the initial training in HLH in July
2009. Early 2011 we noticed that this would be to soon because the curriculum
of HMS-BAB was not finished yet, so we delayed the intervention to November
2011. In November 2011 we encountered another problem; the IRB clearance for
the training was lost for the second time at the NIMR head quarters. The goal
will now be that the initial training will be given in January or February
2012, depending on Jhpiego
personnel to be available for teaching. That means that the assessments of level
2 will take place in January/February 2012 and the 6-month post training
evaluation 6 months after the initial training.
Planned activities for 2012
Jan: finalization of first article about two years of maternal
morbidity and mortality in a rural referral hospital in Tanzania and an
evaluation of the maternal near miss approach, this article will be submitted
to BJOG.
Jan/Feb: Intervention with simulation based training course
HMS-BAB in HLH, assessment of level 1 and 2
Mar: Stakeholder meeting HMS-BAB
Mar/Apr: Data-analysis of level 1 and 2. Write second article
about the evaluation of level 1 and 2
Apr:
20-4-12: presentation of two years of maternal morbidity and mortality in a
rural referral hospital in Tanzania and an evaluation of the maternal near miss
approach at NVTG symposium, Amsterdam.
Jun: SESAM conference Stavanger, an abstract about the evaluation
of level 1 and 2 will be submitted for presentation.
Aug/Sep: 6-month evaluation level 2
Sep/Oct: Data-analysis of level 1, 2 and 3. Write third article
about the evaluation of level 1, 2 and 3.
Oct: FIGO world congress, Rome. Two abstracts will be submitted
for presentation. The first abstract will be about two years of maternal
morbidity and mortality in a rural referral hospital in Tanzania and an
evaluation of the maternal near miss approach. The second abstract will be
about the evaluation of level 1, 2 and 3.
Conclusion
Overall, the research project goes very well, especially
considering this research is taking place in a low-income country. All credits
go to E. Mduma, the research manager and the research assistants working
in Maternity Ward of HLH. The data collection is in place, the quality of the
data is guaranteed. We only have encountered some delay in the intervention,
but that will not harm the goal of disseminate the results in 2012 and 2013. I
still expect to finish my thesis and defend my PhD by the end of 2013.
