Communities, birth attendants and health facilities

A continuum of emergency maternal and newborn care (the global network's EmONC trial)

Omrana Pasha, Robert L. Goldenberg, Elizabeth M. McClure, Sarah Saleem, Shivaprasad S. Goudar, Fernando Althabe, Archana Patel, Fabian Esamai, Ana Garces, Elwyn Chomba, Manolo Mazariegos, Bhala Kodkany, Jose M. Belizan, Richard J. Derman, Patricia L. Hibberd, Waldemar A. Carlo, Edward A. Liechty, K. Michael Hambidge, Pierre Buekens, Dennis Wallace & 5 others Lisa Howard-Grabman, Suzanne Stalls, Marion Koso-Thomas, Alan H. Jobe, Linda L. Wright

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes.Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality.Discussion: In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries.Trial Registration: ClinicalTrials.gov NCT01073488.

Original languageEnglish
Article number82
JournalBMC Pregnancy and Childbirth
Volume10
DOIs
StatePublished - Dec 14 2010

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Health Facilities
Emergencies
Mothers
Parturition
Newborn Infant
Obstetrics
Pregnancy Outcome
Quality of Health Care
Perinatal Mortality
Infant Mortality
Guatemala
Zambia
Eclampsia
Maternal Death
Stillbirth
Maternal Mortality
Kenya
Pakistan
Argentina
Women's Health

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Communities, birth attendants and health facilities : A continuum of emergency maternal and newborn care (the global network's EmONC trial). / Pasha, Omrana; Goldenberg, Robert L.; McClure, Elizabeth M.; Saleem, Sarah; Goudar, Shivaprasad S.; Althabe, Fernando; Patel, Archana; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Mazariegos, Manolo; Kodkany, Bhala; Belizan, Jose M.; Derman, Richard J.; Hibberd, Patricia L.; Carlo, Waldemar A.; Liechty, Edward A.; Hambidge, K. Michael; Buekens, Pierre; Wallace, Dennis; Howard-Grabman, Lisa; Stalls, Suzanne; Koso-Thomas, Marion; Jobe, Alan H.; Wright, Linda L.

In: BMC Pregnancy and Childbirth, Vol. 10, 82, 14.12.2010.

Research output: Contribution to journalArticle

Pasha, O, Goldenberg, RL, McClure, EM, Saleem, S, Goudar, SS, Althabe, F, Patel, A, Esamai, F, Garces, A, Chomba, E, Mazariegos, M, Kodkany, B, Belizan, JM, Derman, RJ, Hibberd, PL, Carlo, WA, Liechty, EA, Hambidge, KM, Buekens, P, Wallace, D, Howard-Grabman, L, Stalls, S, Koso-Thomas, M, Jobe, AH & Wright, LL 2010, 'Communities, birth attendants and health facilities: A continuum of emergency maternal and newborn care (the global network's EmONC trial)', BMC Pregnancy and Childbirth, vol. 10, 82. https://doi.org/10.1186/1471-2393-10-82
Pasha, Omrana ; Goldenberg, Robert L. ; McClure, Elizabeth M. ; Saleem, Sarah ; Goudar, Shivaprasad S. ; Althabe, Fernando ; Patel, Archana ; Esamai, Fabian ; Garces, Ana ; Chomba, Elwyn ; Mazariegos, Manolo ; Kodkany, Bhala ; Belizan, Jose M. ; Derman, Richard J. ; Hibberd, Patricia L. ; Carlo, Waldemar A. ; Liechty, Edward A. ; Hambidge, K. Michael ; Buekens, Pierre ; Wallace, Dennis ; Howard-Grabman, Lisa ; Stalls, Suzanne ; Koso-Thomas, Marion ; Jobe, Alan H. ; Wright, Linda L. / Communities, birth attendants and health facilities : A continuum of emergency maternal and newborn care (the global network's EmONC trial). In: BMC Pregnancy and Childbirth. 2010 ; Vol. 10.
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T2 - A continuum of emergency maternal and newborn care (the global network's EmONC trial)

AU - Pasha, Omrana

AU - Goldenberg, Robert L.

AU - McClure, Elizabeth M.

AU - Saleem, Sarah

AU - Goudar, Shivaprasad S.

AU - Althabe, Fernando

AU - Patel, Archana

AU - Esamai, Fabian

AU - Garces, Ana

AU - Chomba, Elwyn

AU - Mazariegos, Manolo

AU - Kodkany, Bhala

AU - Belizan, Jose M.

AU - Derman, Richard J.

AU - Hibberd, Patricia L.

AU - Carlo, Waldemar A.

AU - Liechty, Edward A.

AU - Hambidge, K. Michael

AU - Buekens, Pierre

AU - Wallace, Dennis

AU - Howard-Grabman, Lisa

AU - Stalls, Suzanne

AU - Koso-Thomas, Marion

AU - Jobe, Alan H.

AU - Wright, Linda L.

PY - 2010/12/14

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N2 - Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes.Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality.Discussion: In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries.Trial Registration: ClinicalTrials.gov NCT01073488.

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