Period: 2011

Evaluation of an intervention in the management of obstetric and neonatal emergencies to reduce adverse pregnancy outcomes in low-resource countries (EMONC Study)

Researchers

Fernando Althabe, Agustina Mazzoni, Marina Laski, Ariel Karolinski, Mabel Berrueta

Summary

Background: Fetal and neonatal mortality in low-income countries is at least 10 times higher than in high-income countries. These differences have been related to low access to and low quality of the obstetric and neonatal health care system.

Objective: To evaluate whether a multifaceted intervention based on training at different levels in obstetric and neonatal emergencies reduces fetal and early neonatal mortality.

Methods: This study tested the hypothesis that teams of health providers, administrators, and local residents could address the problem of limited access to obstetric and neonatal health care and consequently achieve a reduction in perinatal mortality in intervention communities compared to control communities. . This cluster-randomized study was conducted in seven geographic areas of 5 low-income and one middle-income country, and evaluated whether an intervention that included a community mobilization component, another institutional-level training of health providers in the management of obstetric and neonatal emergencies would reduce perinatal mortality at 28 weeks or more of gestation or in newborns weighing more than 1000 grams.

Results: Despite the efforts made by all sites in compliance with the intervention, there were no differences in relation to the primary or secondary outcomes in the intervention clusters versus the control clusters. In both groups, the mean perinatal mortality was 40.1/1000 births (P = 0.9996). No differences were also observed in the two groups in the results of the last 6 months of the project, in the year after the end of the intervention, nor in the conglomerates that best implemented the intervention.

Conclusions: This large-scale, broad and multi-sector randomized study did not have an impact on the evaluated results. This does not reduce the importance of the intervention carried out, since we believe that to improve pregnancy outcomes in these places it would have been necessary to have better obstetric and neonatal infrastructure than that available during the study, since without this it is not enough to train health providers and mobilize the community. Our results highlight the importance of evaluating results in randomized studies, since interventions that are believed to be effective may not be so.

Objectives

To evaluate whether a multifaceted intervention based on training at different levels in obstetric and neonatal emergencies reduces fetal and early neonatal mortality.

Finance

Global Network for Research in Women's and Children's Health. National Institute of Child Health and Human Development (NICHD), Bethesda, MD

Publications

Pasha O, McClure EM, Wright LL, Saleem S, Goudar SS, Chomba E, Patel A, Esamai F, Garces A, Althabe F, Kodkany B, Mabeya H, Manasyan A, Carlo WA, Derman RJ, Hibberd PL, Liechty EK , Krebs N, Hambidge KM, Buekens P, Moore J, Jobe AH, Koso-Thomas M, Wallace DD, Stalls S, Goldenberg RL. A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: a Global Network cluster randomized trial. BMC Med. 2013 Oct 3;11(1):215. [Full text] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853358/pdf/1741-7015-11-215.pdf

Omrana Pasha, Robert L Goldenberg, Elizabeth M McClure, Sarah Saleem, Shivaprasad S Goudar, Fernando Althabe, Archana Patel, Fabian Esamai, Ana Garces, Elwyn Chomba, Manolo Mazariegos, Bhala Kodkany, Jose M Belizan, Richard J Derman, Patricia L Hibberd , Waldemar A Carlo, Edward A Liechty, K Michael Hambidge, Pierre Buekens, Dennis Wallace, Lisa Howard-Grabman, Suzanne Stalls, Marion Koso-Thomas, Alan H Jobe, Linda L Wright. Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the global network's EmONC trial). BMC Pregnancy Childbirth. 2010; 10: 82. Published online 2010 December 14. doi: 10.1186/1471-2393-10-82. [Full text] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017016/pdf/1471-2393-10-82.pdf