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

描述（由申请人提供）：尽管赞比亚的死亡率在过去十年中略有下降，但赞比亚的孕产妇和幼儿死亡负担仍然是世界上最高的。在此应用中，我们寻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来改善卢萨卡省的孕产妇和儿童结局。转诊服务对于及时治疗并发症至关重要，并且必须与基于社区的举措一起加强，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的新方法加强培训，包括病人接触模拟、基于团队的技能培训、应急演习和教师参与。其次，我们将通过实施医疗指南并通过定期围产期审核确保其遵守来规范和改进临床护理。第三，我们将把我们的医学教育模式扩展到以社区为基础的护士和助产士培训，将我们的患者接触模拟纳入紧急产科护理、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，重点是对孕产妇和幼儿死亡率的全面监测。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来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，我们组建了一支由来自三个主要机构的临床医生教育者和医生科学家组成的强大团队：赞比亚大学、赞比亚传染病研究中心和阿拉巴马大学伯明翰分校。通过在 UNZA MEPI 奖的管理结构内开展工作，我们充分利用这些资金来解决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：全世界怀孕期间和分娩前后的死亡风险仍然高得令人无法接受。尽管许多人试图扩大社区一级的服务范围，但这种努力必须同时加强基于设施的护理。该应用程序旨在提高赞比亚一家三级护理机构的临床护理和培训质量，并证明其对人口水平结果的影响。

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.