title: Impact of ALSO training on the management of prolonged labor and neonatal care at Kagera Regional Hospital, Tanzania.
abstract: OBJECTIVE
  To evaluate the management of prolonged labor and neonatal care before and after Advanced Life Support in Obstetrics (ALSO) training.
  
  
  METHODS
  Staff involved in childbirth at Kagera Regional Hospital, Tanzania, attended a 2-day ALSO provider course. In this prospective intervention study conducted between July and November 2008, the management and outcomes of 558 deliveries before and 550 after the training were observed.
  
  
  RESULTS
  There was no significant difference in the rate of cesarean deliveries owing to prolonged labor, and vacuum delivery was not practiced after the intervention. During prolonged labor, action was delayed for more than 3 hours in half of the cases. The stillbirth rate, Apgar scores, and frequency of neonatal resuscitation did not change significantly. After the intervention, there was a significant increase in newborns given to their mothers within 10 minutes, from 5.6% to 71.5% (RR 12.71; 95% CI, 9.04-17.88). There was a significant decrease from 6 to 0 neonatal deaths before discharge among those born with an Apgar score after 1 minute of 4 or more (P=0.03).
  
  
  CONCLUSIONS
  ALSO training had no effect on the management of prolonged labor. Early contact between newborn and mother was more frequently practiced after ALSO training and the immediate neonatal mortality decreased.
authors.affiliation: Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen K, Denmark. bjso@sund.ku.dk
authors.forename: Bjarke Lund
authors.initials: BL
authors.lastname: Sorensen
authors.forename: Vibeke
authors.initials: V
authors.lastname: Rasch
authors.forename: Siriel
authors.initials: S
authors.lastname: Massawe
authors.forename: Juma
authors.initials: J
authors.lastname: Nyakina
authors.forename: Peter
authors.initials: P
authors.lastname: Elsass
authors.forename: Birgitte Bruun
authors.initials: BB
authors.lastname: Nielsen
mesh_terms: D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007224:Infant Care; D007226:Infant Mortality; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008020:Life Support Care; D009774:Obstetrics / Q000193:education* / Q000379:methods; D036801:Parturition; D011247:Pregnancy; D011446:Prospective Studies; D012151:Resuscitation; D050497:Stillbirth; D013636:Tanzania; D016896:Treatment Outcome; D014620:Vacuum Extraction, Obstetrical; D000078329:Workforce