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1. Gill CJ, Phiri-Mazala G, Guerina NG, Kasimba J, Mulenga C, MacLeod WB, Waitolo N, Knapp AB, Mirochnick M, Mazimba A, Fox MP, Sabin L, Seidenberg P, Simon JL, Hamer DH: Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. BMJ; 2011 Feb 03;342:d346
ClinicalTrials.gov. clinical trials - ClinicalTrials.gov .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study.
  • OBJECTIVE: To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare.
  • DESIGN: Prospective, cluster randomised and controlled effectiveness study.
  • SETTING: Lufwanyama, an agrarian, poorly developed district located in the Copperbelt province, Zambia.
  • All births carried out by study birth attendants occurred at mothers' homes, in rural village settings.
  • PARTICIPANTS: 127 traditional birth attendants and mothers and their newborns (3559 infants delivered regardless of vital status) from Lufwanyama district.
  • INTERVENTIONS: Using an unblinded design, birth attendants were cluster randomised to intervention or control groups.
  • The intervention had two components: training in a modified version of the neonatal resuscitation protocol, and single dose amoxicillin coupled with facilitated referral of infants to a health centre.
  • Control birth attendants continued their existing standard of care (basic obstetric skills and use of clean delivery kits).
  • MAIN OUTCOME MEASURES: The primary outcome was the proportion of liveborn infants who died by day 28 after birth, with rate ratios statistically adjusted for clustering.
  • Secondary outcomes were mortality at different time points; and comparison of causes of death based on verbal autopsy data.
  • RESULTS: Among 3497 deliveries with reliable information, mortality at day 28 after birth was 45% lower among liveborn infants delivered by intervention birth attendants than control birth attendants (rate ratio 0.55, 95% confidence interval 0.33 to 0.90).
  • The greatest reductions in mortality were in the first 24 hours after birth: 7.8 deaths per 1000 live births for infants delivered by intervention birth attendants compared with 19.9 per 1000 for infants delivered by control birth attendants (0.40, 0.19 to 0.83).
  • Deaths due to birth asphyxia were reduced by 63% among infants delivered by intervention birth attendants (0.37, 0.17 to 0.81) and by 81% within the first two days after birth (0.19, 0.07 to 0.52).
  • Stillbirths and deaths from serious infection occurred at similar rates in both groups.
  • CONCLUSIONS: Training traditional birth attendants to manage common perinatal conditions significantly reduced neonatal mortality in a rural African setting.
  • This approach has high potential to be applied to similar settings with dispersed rural populations.
  • Trial registration Clinicaltrials.gov NCT00518856.
  • [MeSH-major] Clinical Competence / standards. Delivery, Obstetric / education. Infant Mortality. Infant, Newborn, Diseases / mortality. Midwifery / education. Pregnancy Outcome / epidemiology
  • [MeSH-minor] Adult. Anti-Bacterial Agents / therapeutic use. Cluster Analysis. Female. Humans. Infant, Newborn. Middle Aged. Pregnancy. Prospective Studies. Referral and Consultation. Resuscitation. Rural Health. Zambia / epidemiology

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  • (PMID = 21292711.001).
  • [ISSN] 1756-1833
  • [Journal-full-title] BMJ (Clinical research ed.)
  • [ISO-abbreviation] BMJ
  • [Language] eng
  • [Databank-accession-numbers] ClinicalTrials.gov/ NCT00518856
  • [Grant] United States / NIAID NIH HHS / AI / K23 AI 62208
  • [Publication-type] Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Anti-Bacterial Agents
  • [Other-IDs] NLM/ PMC3032994
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