CONTEXT: The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A "train the teachers" approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje. OBJECTIVES: To describe the development, implementation and evaluation of the educational intervention. METHODS: A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR. RESULTS: A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%. CONCLUSIONS: The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the "train the teachers" approach, with concurrent strengthening of the infrastructure and organisational framework.
CONTEXT: The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A "train the teachers" approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje. OBJECTIVES: To describe the development, implementation and evaluation of the educational intervention. METHODS: A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR. RESULTS: A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%. CONCLUSIONS: The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the "train the teachers" approach, with concurrent strengthening of the infrastructure and organisational framework.
Authors: Zulfiqar A Bhutta; Gary L Darmstadt; Rachel A Haws; Mohammad Yawar Yakoob; Joy E Lawn Journal: BMC Pregnancy Childbirth Date: 2009-05-07 Impact factor: 3.007
Authors: Stephen N Wall; Anne C C Lee; Susan Niermeyer; Mike English; William J Keenan; Wally Carlo; Zulfiqar A Bhutta; Abhay Bang; Indira Narayanan; Iwan Ariawan; Joy E Lawn Journal: Int J Gynaecol Obstet Date: 2009-10 Impact factor: 3.561
Authors: K C Ashish; Mats Målqvist; Johan Wrammert; Sheela Verma; Dhan Raj Aryal; Robert Clark; P K C Naresh; Ravi Vitrakoti; Kedar Baral; Uwe Ewald Journal: BMC Pediatr Date: 2012-10-05 Impact factor: 2.125
Authors: Anne C C Lee; Simon Cousens; Stephen N Wall; Susan Niermeyer; Gary L Darmstadt; Waldemar A Carlo; William J Keenan; Zulfiqar A Bhutta; Christopher Gill; Joy E Lawn Journal: BMC Public Health Date: 2011-04-13 Impact factor: 3.295
Authors: Janet A Curran; Allyson J Gallant; Helen Wong; Hwayeon Danielle Shin; Robin Urquhart; Julia Kontak; Lori Wozney; Leah Boulos; Zulfiqar Bhutta; Etienne V Langlois Journal: BMJ Open Date: 2022-01-17 Impact factor: 2.692
Authors: Janet I Vaughan; Heather E Jeffery; Camille Raynes-Greenow; Adrienne Gordon; Jane Hirst; David A Hill; Susan Arbuckle Journal: BMC Med Educ Date: 2012-11-06 Impact factor: 2.463
Authors: Luis F Vélez; Mary Sanitato; Donna Barry; Martin Alilio; Franklin Apfel; Gloria Coe; Amparo Garcia; Michelle Kaufman; Jonathan Klein; Vesna Kutlesic; Lisa Meadowcroft; Wendy Nilsen; Gael O'Sullivan; Stefan Peterson; Daniel Raiten; Susan Vorkoper Journal: J Health Commun Date: 2014