Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the global network's EmONC trial)

• Autores: 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; Derman, Richard J.; Hibberd, Patricia L.; Carlo, Waldemar A.; Liechty, Edward A.; Hambidge, K Michael Michael; Buekens, Pierre; Wallace, Dennis; Howard Grabman, Lisa; Stalls, Suzanne; Koso Thomas, Marion; Jobe, Alan H.; Wright, Linda L.
• Año de publicación: 2010
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: Maternal; Women; Mortality
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

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.
Fil: Pasha, Omrana. Aga Khan University; Pakistán
Fil: Goldenberg, Robert L.. Drexel University; Estados Unidos
Fil: McClure, Elizabeth M.. Research Triangle Institute; Estados Unidos
Fil: Saleem, Sarah. Aga Khan University; Pakistán
Fil: Goudar, Shivaprasad S.. Jawaharlal Nehru Medical College; India
Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Patel, Archana. Indira Gandhi Government Medical College; India
Fil: Esamai, Fabian. Moi University; Kenia
Fil: Garces, Ana. Universidad de San Carlos de Guatemala;
Fil: Chomba, Elwyn. University of Zambia; Zambia
Fil: Mazariegos, Manolo. Eclamp; Guatemala
Fil: Kodkany, Bhala. Jawaharlal Nehru Medical College; India
Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Derman, Richard J.. Christiana Health Care; Estados Unidos
Fil: Hibberd, Patricia L.. Partners Health Organization; Estados Unidos
Fil: Carlo, Waldemar A.. University of Alabama at Birmingahm; Estados Unidos
Fil: Liechty, Edward A.. Indiana University; Estados Unidos
Fil: Hambidge, K Michael Michael. University of Colorado; Estados Unidos
Fil: Buekens, Pierre. University of Tulane; Estados Unidos
Fil: Wallace, Dennis. Research Triangle Institute; Estados Unidos
Fil: Howard Grabman, Lisa. TRG Incorporated; Estados Unidos
Fil: Stalls, Suzanne. No especifíca;
Fil: Koso Thomas, Marion. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos
Fil: Jobe, Alan H.. Cincinnati Children's Hospital; Estados Unidos
Fil: Wright, Linda L.. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos