Claudia Hanson1,2, Susan Atuhairwe3,4, Joyce Lucy Atim5,6, Gaetano Marrone1, Jessica L Morris7, Frank Kaharuza4,8. 1. Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 2. Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK. 3. Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda. 4. Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda. 5. Mbale Regional Referral Hospital, Mbale, Uganda. 6. Uganda Nurses and Midwives Union, Kampala, Uganda. 7. FIGO (International Federation of Gynecology and Obstetrics), London, UK. 8. Makerere University School of Public Health, Kampala, Uganda.
Abstract
OBJECTIVE: To assess the effect of Helping Mothers Survive Bleeding after Birth training on postpartum hemorrhage (PPH) near miss and case fatality rates in Uganda. METHODS: Training was evaluated using a cluster-randomized design between June 2016 and September 2017 in 18 typical rural districts (clusters) in Eastern and Central Uganda of which nine districts were randomly assigned to the intervention. The main outcome was PPH near miss defined using the World Health Organization's disease and management-based approach. Interrupted time series analysis was performed to estimate the difference in the change of outcomes. RESULTS: Outcomes of 58 000 and 95 455 deliveries during the 6-month baseline and 10-month endline periods, respectively, were included. A reduction of PPH near misses was observed in the intervention compared to the comparison districts (difference-in-difference of slopes 4.19, 95% CI, -7.64 to -0.74); P<0.05). There was an increase in overall reported near miss cases (difference-in-difference 1.24, 95% CI, 0.37-2.10; P<0.001) and an increase in PPH case fatality rate (difference-in-difference 2.13, 95% CI, 0.14-4.12; P<0.05). CONCLUSION: This pragmatic cluster-randomized trial conducted in typical rural districts of Uganda indicated a reduction of severe PPH cases while case fatality did not improve, suggesting that this basic training needs to be complemented by additional measures for sustained mortality reduction. TRIAL REGISTRATION: PACTR201604001582128.
RCT Entities:
OBJECTIVE: To assess the effect of Helping Mothers Survive Bleeding after Birth training on postpartum hemorrhage (PPH) near miss and case fatality rates in Uganda. METHODS: Training was evaluated using a cluster-randomized design between June 2016 and September 2017 in 18 typical rural districts (clusters) in Eastern and Central Uganda of which nine districts were randomly assigned to the intervention. The main outcome was PPH near miss defined using the World Health Organization's disease and management-based approach. Interrupted time series analysis was performed to estimate the difference in the change of outcomes. RESULTS: Outcomes of 58 000 and 95 455 deliveries during the 6-month baseline and 10-month endline periods, respectively, were included. A reduction of PPH near misses was observed in the intervention compared to the comparison districts (difference-in-difference of slopes 4.19, 95% CI, -7.64 to -0.74); P<0.05). There was an increase in overall reported near miss cases (difference-in-difference 1.24, 95% CI, 0.37-2.10; P<0.001) and an increase in PPH case fatality rate (difference-in-difference 2.13, 95% CI, 0.14-4.12; P<0.05). CONCLUSION: This pragmatic cluster-randomized trial conducted in typical rural districts of Uganda indicated a reduction of severe PPH cases while case fatality did not improve, suggesting that this basic training needs to be complemented by additional measures for sustained mortality reduction. TRIAL REGISTRATION: PACTR201604001582128.
Authors: Friday Ebhodaghe Okonofua; Bola Ekezue; Lorretta Favour Chizomam Ntoimo; C Ekwo; V Ohenhen; K Agholor; Brian Igboin; Wilson Imongan; H Galadanci; R Ogu Journal: BMJ Glob Health Date: 2022-04