title: The impact of emergency obstetric care training in Somaliland, Somalia.
abstract: OBJECTIVE
  To provide and evaluate in-service training in "Life Saving Skills - Emergency Obstetric and Newborn Care" in order to improve the availability of emergency obstetric care (EmOC) in Somaliland.
  
  
  METHODS
  In total, 222 healthcare providers (HCPs) were trained between January 2007 and December 2009. A before-after study was conducted using quantitative and qualitative methods to evaluate trainee reaction and change in knowledge, skills, and behavior, in addition to functionality of healthcare facilities, during and immediately after training, and at 3 and 6 months post-training.
  
  
  RESULTS
  The HCPs reacted positively to the training, with a significant improvement in 50% of knowledge and 100% of skills modules assessed. The HCPs reported improved confidence in providing EmOC. Basic and comprehensive EmOC healthcare facilities provided 100% of expected signal functions-compared with 43% and 56%, respectively, at baseline-with trained midwives performing skills usually performed by medical doctors. Lack of drugs, supplies, medical equipment, and supportive policy were identified as barriers that could contribute to nonuse of new skills and knowledge acquired.
  
  
  CONCLUSIONS
  The training impacted positively on the availability and quality of EmOC and resulted in "up-skilling" of midwives.
authors.affiliation: Maternal and Newborn Health Unit, Liverpool School of Tropical Medicine, Liverpool, UK. caameh@liverpool.ac.uk
authors.forename: Charles
authors.initials: C
authors.lastname: Ameh
authors.forename: Adetoro
authors.initials: A
authors.lastname: Adegoke
authors.forename: Jan
authors.initials: J
authors.lastname: Hofman
authors.forename: Fouzia M
authors.initials: FM
authors.lastname: Ismail
authors.forename: Fatuma M
authors.initials: FM
authors.lastname: Ahmed
authors.forename: Nynke
authors.initials: N
authors.lastname: van den Broek
mesh_terms: D002983:Clinical Competence; D003906:Developing Countries; D004635:Emergency Medicine / Q000193:education; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006297:Health Services Accessibility; D006801:Humans; D007318:Inservice Training; D008880:Midwifery / Q000193:education*; D007744:Obstetric Labor Complications / Q000628:therapy*; D009774:Obstetrics / Q000193:education; D011247:Pregnancy; D012998:Somalia