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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