ArticleBMJ global health2019
Effect of the competency-based
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Implementation strategies for WHO guidelines to prevent, detect, and treat postpartum hemorrhage.The Cochrane database of systematic reviews · 2025Pooled it
- Perceptions and experiences of the prevention, detection, and management of postpartum haemorrhage: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2023Pooled it
- An assessment of the effects of simulation training on management of postpartum hemorrhage: short- and long-term impact on knowledge retention, skills and teamwork in the Democratic Republic of Congo.BMC medical education · 2025Trial
- Effects of the Helping Mothers Survive Bleeding after Birth training on near miss morbidity and mortality in Uganda: A cluster-randomized trial.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2021Trial
- Trial
- Impact of the Zero Maternal Death by Hemorrhage Strategy on health professionals' self-perceived knowledge in managing postpartum hemorrhage.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2025Article
- Virtual simulation training for postpartum hemorrhage in low-to-moderate-volume hospitals in the US.AJOG global reports · 2024Article
- Development of antepartum risk prediction model for postpartum hemorrhage in Lagos, Nigeria: A prospective cohort study (Predict-PPH study).International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2024Article
- Implementation of a three-pillar training intervention to improve maternal and neonatal healthcare in the Democratic Republic Of Congo: a process evaluation study in an urban health zone.Global health action · 2022Article
- Health workers' experiences of implementation of Helping Mothers Survive Bleeding after Birth training in Tanzania: a process evaluation using the i-PARIHS framework.BMC health services research · 2022Article
- Risk factors for postpartum haemorrhage in the Northern Province of Rwanda: A case control study.PloS one · 2022Observational
- Action leveraging evidence to reduce perinatal mortality and morbidity (ALERT): study protocol for a stepped-wedge cluster-randomised trial in Benin, Malawi, Tanzania and Uganda.BMC health services research · 2021Article
- SaferBirths bundle of care protocol: a stepped-wedge cluster implementation project in 30 public health-facilities in five regions, Tanzania.BMC health services research · 2021Article
- Formative research to design an implementation strategy for a postpartum hemorrhage initial response treatment bundle (E-MOTIVE): study protocol.Reproductive health · 2021Article
- Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania.BMC pregnancy and childbirth · 2021Article
- "We do what we can do to save a woman" health workers' perceptions of health facility readiness for management of postpartum haemorrhage.Global health action · 2020Article
- Rater training for standardised assessment of Objective Structured Clinical Examinations in rural Tanzania.BMJ paediatrics open · 2020Article
- Helping Mothers Survive: Program Evaluation and Early Outcomes of Maternal Care Training in the Dominican Republic.Frontiers in public healthArticle
- The Effect of Obstetric Drills Training - Jamaica Core Obstetric Teaching and Training in Emergencies (JOTTIE) on Postpartum Haemorrhage at a Jamaican Teaching Hospital.Journal of medical education and curricular developmentArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTraining health providers is an important strategy to improve health. We conducted a cluster-randomised two-arm trial in Tanzania to assess the effect of a 1-day competency-based training 'Helping Mothers Survive Bleeding after Birth (HMS BAB)' followed by eight weekly drills on postpartum haemorrhage (PPH)-related morbidity and mortality.
methodsTwenty districts in four purposefully selected regions in Tanzania included 61 facilities. The districts were randomly allocated using matched pairs to ensure similarity in terms of district health services in intervention and comparison districts. In the 10 intervention districts 331 health providers received the HMS BAB training. The other half continued with standard practices. We used the WHO's near miss tool to collect information on severe morbidity (near misses) of all women admitted to study facilities. We performed interrupted time series analysis to estimate differences in the change of near miss per delivery rate and case fatality rates. We also assessed implementation of evidence-based preventive and basic management practices for PPH as secondary outcomes.
resultsWe included 120 533 facility deliveries, 6503 near misses and 202 maternal deaths in study districts during study period (November 2014 to January 2017). A significant reduction of PPH near misses was found among women who suffered PPH in the intervention district compared with comparison districts (difference-in-differences of slopes -5.3, 95% CI -7.8 to -2.7, p<0.001) from a baseline PPH-related near miss rate of 71% (95% CI 60% to 80%). There was a significant decrease in the long-term PPH near miss case fatality (difference-in-differences of slopes -4 to 0) (95% CI -6.5 to -1.5, p<0.01) in intervention compared with the comparison districts. The intervention had a positive effect on the proportion of PPH cases treated with intravenous oxytocin (difference-in-differences of slopes 5.2, 95% CI 1.4 to 8.9) (p <0.01).
conclusionThe positive effect of the training intervention on PPH morbidity and case fatality suggests that the training addresses important deficits in knowledge and skills. TRIAL REGISTRATION NUMBER: PACTR201604001582128.
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