Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study
Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study
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DOI：
10.1136/bmj.d346
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发表时间：
2011-02-03
影响因子：
105.7
通讯作者：
Hamer, Davidson H.
中科院分区：
文献类型：
--
作者：
Gill, Christopher J.;Phiri-Mazala, Grace;Hamer, Davidson H.
Objective To determine whether training traditional birth attendants to manage several common peripheral conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare.Design Prospective，cluster randomized and controlled effectiveness study.Setting Lufwanyama，an agricarian，poor developed district located in the Copperbelt province，Zambia.所有分娩进行的研究助产士发生在母亲的家，在农村village settings.Participants 127传统的助产士和母亲和他们的新生儿（3559名婴儿交付，无论生命状态）从Lufwanyama district.Interventions使用非盲设计，助产士被随机分组到干预组或对照组。干预措施有两个组成部分：培训新生儿复苏方案的修订版，以及单剂量阿莫西林，并协助将婴儿转诊到保健中心。控制助产士继续其现有的护理标准（基本产科技能和使用清洁的分娩工具包）。主要结果measures的主要结果是活产婴儿的比例谁出生后第28天死亡，率比统计学调整集群。次要结果是死亡率在不同的时间点，死因的比较，死因出生后24小时内的死亡率下降幅度最大：由干预助产士接生的婴儿每1 000名活产死亡7.8人，而由对照助产士接生的婴儿每1 000名活产死亡19.9人（0.40，0.19至0.83）。由干预性助产士接生的婴儿因出生窒息而死亡的人数减少了63%（0.37，0.17至0.81），出生后头两天内的死亡人数减少了81%（0.19，0.07至0.52）。死产和死亡的严重感染发生在这两个group.Conclusions培训传统的助产士管理常见的围产期条件显着降低新生儿死亡率在非洲农村地区的设置。这一方法很有可能适用于农村人口分散的类似情况。
Objective To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare.Design Prospective, cluster randomised and controlled effectiveness study.Setting Lufwanyama, an agrarian, poorly developed district located in the Copperbelt province, Zambia. All births carried out by study birth attendants occurred at mothers' homes, in rural village settings.Participants 127 traditional birth attendants and mothers and their newborns (3559 infants delivered regardless of vital status) from Lufwanyama district.Interventions Using an unblinded design, birth attendants were cluster randomised to intervention or control groups. The intervention had two components: training in a modified version of the neonatal resuscitation protocol, and single dose amoxicillin coupled with facilitated referral of infants to a health centre. Control birth attendants continued their existing standard of care (basic obstetric skills and use of clean delivery kits).Main outcome measures The primary outcome was the proportion of liveborn infants who died by day 28 after birth, with rate ratios statistically adjusted for clustering. Secondary outcomes were mortality at different time points; and comparison of causes of death based on verbal autopsy data.Results Among 3497 deliveries with reliable information, mortality at day 28 after birth was 45% lower among liveborn infants delivered by intervention birth attendants than control birth attendants (rate ratio 0.55, 95% confidence interval 0.33 to 0.90). The greatest reductions in mortality were in the first 24 hours after birth: 7.8 deaths per 1000 live births for infants delivered by intervention birth attendants compared with 19.9 per 1000 for infants delivered by control birth attendants (0.40, 0.19 to 0.83). Deaths due to birth asphyxia were reduced by 63% among infants delivered by intervention birth attendants (0.37, 0.17 to 0.81) and by 81% within the first two days after birth (0.19, 0.07 to 0.52). Stillbirths and deaths from serious infection occurred at similar rates in both groups.Conclusions Training traditional birth attendants to manage common perinatal conditions significantly reduced neonatal mortality in a rural African setting. This approach has high potential to be applied to similar settings with dispersed rural populations.