Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality.
OBJECTIVE
To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes.


METHODS
Population-based, prospective, interventional pre-post design study.


METHODS
11 rural clusters in Chimaltenango, Guatemala.


METHODS
Health care providers.


METHODS
This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006.


METHODS
The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g.


RESULTS
Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57).


CONCLUSIONS
Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability.
IMSALUD, Guatemala City, Guatemala. anagarces@imsalud.org
Ana
A
Garcés
Elizabeth M
EM
McClure
Michael
M
Hambidge
Nancy F
NF
Krebs
Manolo
M
Mazariegos
Linda L
LL
Wright
Janet
J
Moore
Waldemar A
WA
Carlo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D015331:Cohort Studies; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000193:education*; D018743:Perinatal Care / Q000592:standards*; D054238:Perinatal Mortality; D011247:Pregnancy; D011446:Prospective Studies; D050497:Stillbirth / Q000453:epidemiology; D014944:World Health Organization; D055815:Young Adult