Linked: Improving maternal & child health through specialty training in Zambia

描述（申请人提供）：尽管过去十年来死亡率略有下降，但赞比亚的孕产妇和幼儿死亡负担仍然是世界上最高的。在这一应用中，我们力求通过加强赞比亚大学医学院的产科和新生儿护理专业培训，改善卢萨卡省的孕产妇和儿童成果。急需转诊服务，以便及时治疗并发症，而且必须在采取社区举措的同时加强转诊服务，以改善孕产妇和儿童健康。我们在四个具体目标的背景下描述我们的医学教育计划。首先，我们将通过医学教育中的新方法加强培训，包括患者遭遇模拟，基于团队的技能培训，应急演习和教师参与。第二，我们将通过执行医疗准则并通过定期围产期审计确保遵守这些准则，规范和改善临床护理。第三，我们将扩大我们的医学教育模式，以社区为基础的护士和助产士培训，将我们的病人遇到模拟纳入产科急诊，新生儿复苏和基本新生儿护理。最后，为了评估这些干预措施的影响，我们将制定一个项目评估和成果研究框架，重点是全面监测孕产妇和幼儿死亡率。这种对患者结果的重视是我们计划的一个独特特征，并将提供有价值的信息，以告知我们干预措施的成本效益和可持续性。为了实现这些目标，我们组建了一个强大的团队，由来自三个主要机构的临床教育工作者和医生科学家组成：赞比亚大学，赞比亚传染病研究中心和伯明翰的亚拉巴马大学。通过在UNZA的MEPI奖的行政结构内工作，我们充分利用这些资金来解决一个既定的全球卫生优先事项-使怀孕和分娩更安全-并为赞比亚未来的健康改善提供框架。 公共卫生相关性：在全世界范围内，怀孕期间和分娩前后的死亡风险仍然高得不可接受。虽然许多国家努力扩大社区一级的服务，但在作出这些努力的同时，还必须加强以设施为基础的护理。该应用程序旨在提高赞比亚一个三级保健设施的临床护理和培训质量，并展示其对人口一级结果的影响。

DESCRIPTION (provided by applicant): Despite modest reductions in mortality over the past decade, the burden of maternal and early childhood death in Zambia remains among the highest in the world. In this application, we seek to improve maternal and child outcomes in Lusaka Province by enhancing specialty training for obstetric and neonatal care at the University of Zambia School of Medicine. Referral services are critically needed for the timely treatment of complications and must be strengthened alongside community-based initiatives to improve maternal and child health. We describe our medical education initiative in the context of four specific aims. First, we will enhance training through novel approaches in medical education, including patient-encounter simulations, team-based skills training, emergency drills, and faculty engagement. Second, we will standardize and improve clinical care by implementing medical guidelines and ensuring their adherence through regular perinatal audits. Third, we will expand our medical education model to community-based nurse and midwife training, integrating our patient-encounter simulations into emergency obstetrical care, neonatal resuscitation, and essential newborn care. Finally, to assess the impact of these interventions, we will develop a framework for program evaluation and outcomes research, focusing on comprehensive surveillance of maternal and early childhood mortality. This emphasis on patient outcomes is a unique feature of our program and will provide value information to inform the cost-effectiveness and sustainability of our interventions. To accomplish these aims, we have assembled a strong team of clinician-educators and physician-scientists from three principal institutions: the University of Zambia, the Centre for Infectious Disease Research in Zambia, and the University of Alabama at Birmingham. By working within the administrative structure of UNZA's MEPI award, we substantially leverage these funds to address a well- established global health priority - making pregnancy and delivery safer - and to provide the framework for future health improvements across Zambia. PUBLIC HEALTH RELEVANCE: The risk of death during pregnancy and around delivery remains unacceptably high worldwide. While many have sought to expand access of services at the community level, such efforts must be accompanied by enhancements in facility-based care. This application seeks to improve the quality of clinical care and training at one tertiary care facility in Zambia and demonstrate its impact on population-level outcomes.