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1. Matendo R, Engmann C, Ditekemena J, Gado J, Tshefu A, Kinoshita R, McClure EM, Moore J, Wallace D, Carlo WA, Wright LL, Bose C: Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect. BMC Med; 2011 Aug 04;9:93
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect.
  • BACKGROUND: In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant.
  • In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity.
  • Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training.
  • The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC) using two established programs.
  • METHODS: This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases.
  • The effect of training using the WHO Essential Newborn Care (ENC) program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP).
  • The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared.
  • In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training.
  • RESULTS: More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training.
  • There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training.
  • However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96), which was independently associated with time following training.
  • The decline was attributable to a decline in early neonatal mortality.
  • NRP training had no demonstrable effect on early neonatal mortality.
  • CONCLUSION: Training DRC birth attendants using the ENC program reduces perinatal mortality.
  • However, a period of utilization and re-enforcement of training may be necessary before a decline in mortality occurs.
  • ENC training has the potential to be a low cost, high impact intervention in developing countries.
  • TRIAL REGISTRATION: This trial has been registered at http://www.clinicaltrials.gov (identifier NCT00136708).
  • [MeSH-major] Education, Medical / methods. Health Knowledge, Attitudes, Practice. Midwifery / education. Perinatal Mortality / trends
  • [MeSH-minor] Asphyxia Neonatorum / prevention & control. Democratic Republic of the Congo / epidemiology. Female. Humans. Infant, Newborn. Infection Control. Male. Pregnancy. Prospective Studies. Time Factors

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  • (PMID = 21816050.001).
  • [ISSN] 1741-7015
  • [Journal-full-title] BMC medicine
  • [ISO-abbreviation] BMC Med
  • [Language] eng
  • [Databank-accession-numbers] ClinicalTrials.gov/ NCT00136708
  • [Grant] United States / NICHD NIH HHS / HD / U01 HD040636; United States / NICHD NIH HHS / HD / U01 HD043475; United States / NICHD NIH HHS / HD / U01 HD40636
  • [Publication-type] Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC3171324
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