Research & Development

The impact of ALSO training on post partum haemorrhage:
A prospective intervention study at Kagera Regional Hospital in Tanzania.

Objective: To evaluate the impact of ALSO training on the incidence and management of Post Partum Haemorrhage at Kagera Regional Hospital in Tanzania.

Intervention: All high- and midlevel providers involved in childbirth at Kagera Regional Hospital attended a two day Advanced Life Support in Obstetrics (ALSO) provider course.

Results: The incidence of PPH was reduced to 18.2%; from 32.9% relative risk 0.44-0.69, severe PPH to 4.3%; from 9.2% relative risk 0.29-0.77. The active management of third stage labor was significantly increased. There was a significant decrease in episiotomies. Staff identified one in 25 of the PPH cases by visual estimation before the ALSO training, one in five were detected after. A significant higher proportion of women with a measured PPH had continuous uterus massage, oxytocin infusion, misoprostol and an application of bimanual uterus compression.

Conclusion: ALSO training significantly reduced the incidence of PPH to 18.2% from 32.9% while improving the staffs’ management. To reduce maternal morbidity and mortality caused by PPH staff skills must be improved. The two days ALSO provider course seems to be an effective way to improve skills.

Emergency Obstetrics Practical Skills and Written Examination Scores are Retained over 6 months in an East Africa Setting

Objectives: To assess retention of practical and written knowledge in Advanced Life Support in Obstetrics (ALSO) emergency obstetrics methodology after becoming an ALSO instructor or completing an interim refresher course.

Materials and Methods: As a part of an educational program in the department of Obstetrics and Gynecology at the Kilimanjaro Christian Medical Center (KCMC), 40 obstetric providers (Consultants, midwives, residents and interns) underwent training in Advanced Life Support in Obstetrics (ALSO). The training was preceded by a 20 question written examination assessing basic emergency obstetrics knowledge. After the training, they completed the written examination again and also completed a hands-on practical examination. 12 of the course participants underwent further training to be ALSO instructors. Three months after the training, 23 of the providers completed a 15 minute refresher training. At 6 months after the original training, the written and the practical examination was repeated by these 35 participants. They also completed a short survey on their current use of ALSO methodology.

Results: 29 out of 35 (83%) participants passed the practical examination immediately after the course and 31 out of 35 (89%) passed the practical examination at 6 months. The average score on the pre-course written examination was 53.5%. The average score immediately after the training and at 6 months was 73% and 70% respectively. At 6 months, 73% of participants were using ALSO methodology in their practice at least 3 times/week and 94% were using it at least once/week. 93% of participants were using Active Management of the Third Stage of Labor (AMTSL) for all patients for the prevention of postpartum hemorrhage.

Conclusion: At 6 months post-training, there is a high rate of retention of both practical and written knowledge in emergency obstetrics after completing an instructor course or an interim refresher course. There also is a high rate of incorporation of ALSO methodology in to practice and a high rate of AMTSL use. Future randomized, controlled studies to assess the role of refresher courses in enhancing retention in emergency obstetrics knowledge should be considered.

The ALSO Course in Moshi, Tanzania: A Cost Analysis
Objectives: To describe an inexpensive means of dissemination of emergency obstetrics knowledge in a low resource setting in East Africa using the Advanced Life Support in Obstetrics (ALSO) Course.

Materials and Methods: We instituted a teaching program in Advanced Life Support in Obstetrics with the intent of decreasing costs with each successive course in order to continue local and regional dissemination of this material on a low budget.

Results: The first two ALSO courses at the Kilimanjaro Christian Medical Center trained 45 obstetrics providers at total cost of $325/provider including instructor travel and expenses, course materials, mannequins, meals etc. This was followed by an instructor course for 13 participants at a cost of $125/participant. With incorporation of recently trained instructors in to the next course at a nearby district hospital, the cost decreased to $215/participant. Subsequent courses were conducted at a cost of $125/participant.

Conclusions: The ALSO methodology allows rapid, inexpensive dissemination of emergency obstetrics knowledge. With emerging evidence to support the efficacy of ALSO in dealing with obstetric emergencies, this methodology may be preferred because of cost considerations.


 By Bjarke Lund Sørensen


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