Data_Sheet_1_Helping Mothers Survive: Program Evaluation and Early Outcomes of Maternal Care Training in the Dominican Republic.PDF

Introduction: In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers.
Methods: An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia & eclampsia (PE&E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers.
Results: Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016–August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents/interns, nurses, students, and “other.” A significant improvement in knowledge scores was observed for both the BAB and PE&E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&E virtual training pilot workshop in August 2020.
Discussion/Conclusions: Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.

引言：2017年，全球约有29.5万名女性在妊娠期间及分娩后即刻死亡，其中94%的死亡案例发生在资源匮乏地区。多米尼加共和国（Dominican Republic, DR）是拉丁美洲及加勒比地区孕产妇死亡率最高的国家之一，尽管该国报告的在册分娩中99%都有熟练助产士陪护。这一矛盾现象表明，支持医护人员知识与技能提升的项目，对改善多米尼加共和国的孕产妇健康结局至关重要。“帮助母亲存活”（Helping Mothers Survive, HMS）是由Jhpiego及全球合作伙伴开发的医护人员培训项目，其目标是通过加强当地医护人员的孕产妇健康技能培训、推动质量改进工作，以降低孕产妇死亡率。
方法：一个国际性、多部门利益相关方团体合作实施了两项HMS课程：产后出血（Bleeding After Birth, BAB）及子痫前期与子痫（pre-eclampsia & eclampsia, PE&E）。研究记录了每位参与者的人口统计学信息，以及培训前后的知识测评得分。通过评估知识得分的提升情况，以验证该项目对医护人员知识习得的有效性。
结果：2016年10月至2020年8月期间，共有320名医护人员参与了HMS培训工作坊。其中132名学员被培训为骨干培训师。大部分参与者为主治医师，其次为住院医师/实习医师、护士、学员及“其他”群体。产后出血及子痫前期与子痫两项课程的知识得分均出现显著提升，平均分较培训前后分别提升21.24%和30.25%。受新冠疫情防控措施影响，当地团队灵活调整，于2020年8月开展了子痫前期与子痫课程的虚拟培训试点工作坊。
讨论与结论：基于模拟场景的培训提升了参与两项HMS课程的医护人员的知识水平。上述结果表明，培训结束后即刻开展的模拟场景培训班，可有效提升医护人员的知识习得与技能水平。在子痫前期与子痫课程中，线下培训与虚拟培训的知识习得效果无显著差异。持续蔓延的疫情为项目实施带来了挑战，但上述初步研究结果证实，开展虚拟培训工作坊可作为线下培训的可行替代方案。