Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
10787 participants
INTERVENTIONAL
2013-03-31
2014-12-31
Brief Summary
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Detailed Description
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Conditions
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Study Design
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NA
SINGLE_GROUP
NONE
Study Groups
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St. Paul and Networked Health Centers
An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
Training of health workers in Basic Obstetric Emergency Care
Health workers at the eight health centers will be trained in maternal, newborn, and child health (MNCH) care, including all basic emergency obstetric and neonatal care (BEmONC) signal functions and other essential MNCH services. The training is a three week competency-based curriculum developed recently by the Ethiopian Federal Ministry of Health (FMoH).
Hospital-health center networking system
A key intervention will be the creation of an effective, formalized networking system between Saint Paul Millennium Hospital and its eight satellite health centers in Addis Ababa. The networking system will create a conducive environment for the transfer of knowledge and skills between health care providers working at the hospital and in the health centers. Monthly review meetings will bring together staff from the hospital and health centers, and dedicated cell phones will be distributed to improve communication between the networked facilities.
Post Basic Emergency Obstetric Training Mentorship
At Saint Paul Millennium Hospital and the health centers, providers who have undergone BEmONC training will undergo regular monthly mentorship visits for the first six months post training. The frequency of visits after six months will be adjusted based on the retention of BEmONC skills and provider performance
Team-Based Supportive supervision
Saint Paul Hospital will use team-based models to provide supportive supervision to health centers in its network. Representatives of the supportive supervision teams may, in addition to Saint Paul Hospital employees, include representatives from the Addis Ababa Regional Health Bureau.
Midwives exchange program
Saint Paul Millennium Hospital's maternity wards are often over-crowded and have to turn patients away. Health professionals incorrectly refer non-complicated deliveries, resulting in the occupation of beds that should be used for emergency deliveries. This action is attributed to inexperienced midwives at the health center level who are uncomfortable performing normal labor and delivery duties. In order to address this challenge, this project will establish an exchange program in which well-trained, experienced midwives from the hospitals will temporarily exchange places with less-experienced midwives in the health centers. This exchange would allow less-experienced midwives to work in the hospital environment, gaining the experience and confidence necessary to attend normal deliveries and identify appropriate referrals.
Strengthening the referral network
Mechanisms and protocols for smooth communication between the health centers and the hospital have been developed, allowing health centers to utilize the hospital's ambulance, and implementing mechanisms for back referrals and feedback. To facilitate this work, we will support the use of dedicated cell phones in each of the eight networked facilities and at Saint Paul Millennium Hospital, and institute referral log books at both the referring and receiving institutions.
Facility Checklists
Facility checklists will be used daily in each of the facilities to assess readiness for obstetric emergencies. Formally, the checklists will be used at the quarterly supportive supervision visits, to assess improvements over time.
Emergency Drills
Non-punitive obstetric drills will provide multiple measurable indicators of quality maternal care, will illustrate opportunities for improving facility capabilities and provider care, and will allow providers to assess appropriate referral mechanisms and facility readiness. Incorporating emergency drills into current training and at all levels of health facilities will also give providers hands-on experience
Interventions
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Training of health workers in Basic Obstetric Emergency Care
Health workers at the eight health centers will be trained in maternal, newborn, and child health (MNCH) care, including all basic emergency obstetric and neonatal care (BEmONC) signal functions and other essential MNCH services. The training is a three week competency-based curriculum developed recently by the Ethiopian Federal Ministry of Health (FMoH).
Hospital-health center networking system
A key intervention will be the creation of an effective, formalized networking system between Saint Paul Millennium Hospital and its eight satellite health centers in Addis Ababa. The networking system will create a conducive environment for the transfer of knowledge and skills between health care providers working at the hospital and in the health centers. Monthly review meetings will bring together staff from the hospital and health centers, and dedicated cell phones will be distributed to improve communication between the networked facilities.
Post Basic Emergency Obstetric Training Mentorship
At Saint Paul Millennium Hospital and the health centers, providers who have undergone BEmONC training will undergo regular monthly mentorship visits for the first six months post training. The frequency of visits after six months will be adjusted based on the retention of BEmONC skills and provider performance
Team-Based Supportive supervision
Saint Paul Hospital will use team-based models to provide supportive supervision to health centers in its network. Representatives of the supportive supervision teams may, in addition to Saint Paul Hospital employees, include representatives from the Addis Ababa Regional Health Bureau.
Midwives exchange program
Saint Paul Millennium Hospital's maternity wards are often over-crowded and have to turn patients away. Health professionals incorrectly refer non-complicated deliveries, resulting in the occupation of beds that should be used for emergency deliveries. This action is attributed to inexperienced midwives at the health center level who are uncomfortable performing normal labor and delivery duties. In order to address this challenge, this project will establish an exchange program in which well-trained, experienced midwives from the hospitals will temporarily exchange places with less-experienced midwives in the health centers. This exchange would allow less-experienced midwives to work in the hospital environment, gaining the experience and confidence necessary to attend normal deliveries and identify appropriate referrals.
Strengthening the referral network
Mechanisms and protocols for smooth communication between the health centers and the hospital have been developed, allowing health centers to utilize the hospital's ambulance, and implementing mechanisms for back referrals and feedback. To facilitate this work, we will support the use of dedicated cell phones in each of the eight networked facilities and at Saint Paul Millennium Hospital, and institute referral log books at both the referring and receiving institutions.
Facility Checklists
Facility checklists will be used daily in each of the facilities to assess readiness for obstetric emergencies. Formally, the checklists will be used at the quarterly supportive supervision visits, to assess improvements over time.
Emergency Drills
Non-punitive obstetric drills will provide multiple measurable indicators of quality maternal care, will illustrate opportunities for improving facility capabilities and provider care, and will allow providers to assess appropriate referral mechanisms and facility readiness. Incorporating emergency drills into current training and at all levels of health facilities will also give providers hands-on experience
Eligibility Criteria
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Inclusion Criteria
Baseline/Endline:
Key Informant Interviews:
* St. Paul hospital: Maternal Child Health (MCH) Head, Midwife/nurse from Labor and Delivery (L\&D), Midwife/nurse from Emergency
* Health Centers: Medical Director, Head of MCH (midwife) Midwife from L\&D, Referral focal person
Health Facility Assessment:
\- Manager/most senior health worker asked (one from each facility)
Provider Survey:
\- All providers in the MCH at both the hospital and health center level
Chart review:
\- All deliveries in all centers will be screened during the intervention phase. Data on every birth will be collected from the log books of each facility. The data collector will then find the medical record of that patient to assess the Standard of Care (SOC) during Ante-natal care (ANC)- if available from the chart, L\&D and screen for an obstetric complication. If there was a complication, the near miss data will be collected.
Telephone registration log book:
\- all phone calls between HC and Hospital
Facility Checklists:
\- Forms completed by Supportive Supervision Teams at quarterly visits
Standardized BEmONC training evaluation
\- Will be given to every provider undergoing the training, as part of the training curriculum.
Monthly mentoring evaluations - for the six months post-training mentorship, for all providers who have undergone BEmONC training.
Supportive Supervision Gap Identification Checklists
\- Collected quarterly from each of the 9 facilities
ALL
Yes
Sponsors
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Bill and Melinda Gates Foundation
OTHER
Maternal Health Task Force
UNKNOWN
St. Paul's Hospital Millennium Medical College, Ethiopia
OTHER
Addis Continental Institute of Public Health
OTHER
Institute for Clinical Effectiveness and Health Policy
OTHER
Harvard School of Public Health (HSPH)
OTHER
Responsible Party
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Ana Langer
Professor of the Practice of Public Health Coordinator of the Dean's Special Initiative in Women and Health
Principal Investigators
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Ana Langer, MD
Role: PRINCIPAL_INVESTIGATOR
Harvard School of Public Health (HSPH)
Yemane Berhane, MD, MPH, PhD
Role: PRINCIPAL_INVESTIGATOR
Addis Continental Institute of Public Health
Delayehu Bekele, MD
Role: PRINCIPAL_INVESTIGATOR
St. Paul's Hospital Millennium Medical College, Ethiopia
Fernando Althabe, MD
Role: STUDY_DIRECTOR
Institute for Clinical Effectiveness and Health Policy
Locations
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Addis Ketema Health Center
Addis Ketema Subcity, Woreda 4, , Ethiopia
Woreda 7 Health Center
Addis Ketema Subcity, Woreda 9, Addis Ababa,, , Ethiopia
Semen Health Center
Arada Sub City, Addis Ababa, , Ethiopia
Selam Health Center
Gulele Sub City, Woreda 9, Addis Ababa, , Ethiopia
St. Paul Hospital Millennium Medical College
Gulele Subcity, Addis Ababa, , Ethiopia
Shegole Health Center
Gulele Subcity, Woreda 10, Addis Ababa, , Ethiopia
Woreda 7 Health Center
Gulele Subcity, Woreda 7, , Ethiopia
Kolfe Health center
Kolfe Sub City, Woreda 2, Addis Ababa, , Ethiopia
Countries
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Other Identifiers
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MHTF IR Ethiopia
Identifier Type: -
Identifier Source: org_study_id
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