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

描述(申请人提供)：尽管在过去十年中死亡率略有下降，但赞比亚的孕产妇和幼儿死亡负担仍然是世界上最高的之一。在这项申请中，我们寻求通过加强赞比亚大学医学院产科和新生儿护理的专业培训来改善卢萨卡省的孕产妇和儿童结果。转诊服务是及时治疗并发症的迫切需要，必须与以社区为基础的改善妇幼保健的倡议一起得到加强。我们在四个具体目标的背景下描述我们的医学教育倡议。首先，我们将通过医学教育中的新方法来加强培训，包括患者遭遇模拟、基于团队的技能培训、紧急演习和教师参与。第二，规范和改善临床护理，落实医疗指南，并通过定期围产期审计确保其遵守。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，将我们的病人遭遇模拟整合到紧急产科护理、新生儿复苏和基本新生儿护理中。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结果研究的框架，重点是全面监测孕产妇和儿童早期死亡率。这种对患者结果的重视是我们计划的一个独特特点，将提供有价值的信息，为我们干预措施的成本效益和可持续性提供信息。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教育工作者和内科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的MEPI奖项的行政结构内开展工作，我们在很大程度上利用这些资金来解决既定的全球健康优先事项--使怀孕和分娩更安全--并为赞比亚全国未来的健康改善提供框架。 与公共卫生相关：在全球范围内，怀孕期间和分娩前后的死亡风险仍然高得令人无法接受。虽然许多人寻求扩大在社区一级获得服务的机会，但在作出这种努力的同时，必须加强以设施为基础的护理。这项申请旨在提高赞比亚一家三级医疗机构的临床护理和培训质量，并展示其对人口一级成果的影响。

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.