Online Program

Catalyzing change in rural guatemalan childbirth care: Evidence for a low-tech, low cost obstetric and neonatal emergency simulation training program, pronto

Tuesday, November 5, 2013 : 11:30 a.m. - 11:45 a.m.

Francesca Holme, MPH, Department of Global Health, University of Washington, Seattle, WA
Dilys Walker, MD, Department of Global Health, University of Washington, Seattle, WA
Edgar Kestler, PhD, Centro de Investigaci├│n epidemiol├│gica en salud sexual y reproductiva (CIESAR), Guatemala City, Guatemala
Julia Dettinger, MPH, Department of Global Health, University of Washington, Seattle, WA
Monisha Sharma, MPH, Department of Global Health, University of Washington, Seattle, WA
Jimena Fritz, MD, MSc, Department of Reproductive Health, National Institute of Public Health, Cuernavaca, Mexico
Marisela Olvera, MD, MSc, Instituto Nacional de Salud Publica, Mexico, Cuernavaca, Mexico
Jenifer Fahey, MPH, MSN, CNM, Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
Susanna Cohen, DNP, MSN, CNM, College of Nursing, University of Utah, Salt Lake City
Background: Rates of maternal and perinatal mortality in Guatemala remain unacceptably high. PRONTO training uses low-tech, highly realistic simulation to provide the opportunity for medical teams to practice managing obstetric and perinatal emergencies in their daily work environment. It also includes a strategic planning session whereby trainees set goals to address problems in care identified during training. Methods: From 2012-2013 PRONTO International, CIESAR and the Ministry of Health in Guatemala implemented an intervention package to decrease maternal and perinatal mortality. The intervention package included PRONTO trainings in 15 randomly selected rural clinics among 30 clinics meeting selection criteria. We measured provider knowledge and self-efficacy pre- and post- training in key content areas: obstetric hemorrhage, neonatal resuscitation, preeclampsia/eclampsia, and shoulder dystocia. At 3 months after initial training, we assessed progress towards implementation of strategic planning goals to improve childbirth care. Results: 217 providers were trained. Increases in provider knowledge were dramatic and statistically significant, averaging 20.8 percentage points from pre- to post-tests (p<0.0001), as were increases in self-efficacy ratings, averaging 11.2 points on a scale of 0-100 (p<0.0001). Three months later, clinic staff reported accomplishing 68% of strategic goals. Conclusions: PRONTO in Guatemala has succeeded in improving knowledge and self-efficacy among providers for key concepts in obstetric and perinatal emergency care; system changes were also achieved. These results, together with similar findings from PRONTO trials in Mexico, encourage us that PRONTO can improve practices in low-resource clinics and hospitals. Impact data is currently being collected on maternal and perinatal outcomes.

Learning Areas:

Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe a low-cost training program (PRONTO) that aims to improve childbirth outcomes in Guatemala. List at least three important findings of the PRONTO Guatemala study to date. Explain at least two implications for other public health professionals endeavoring to reduce maternal and perinatal mortality globally and locally.

Keyword(s): Health Workers Training, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the primary research coordinator for this study and am intimately familiar with its methods, implementation and results. My experience, training and expertise is in maternal health in Latin America.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4121.0: Maternal & Child Health 2