title: Helping mothers survive bleeding after birth: an evaluation of simulation-based training in a low-resource setting.
abstract: OBJECTIVE
  To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting.
  
  
  METHODS
  Educational intervention study.
  
  
  METHODS
  Rural referral hospital in Northern Tanzania.
  
  
  METHODS
  Clinicians, nurse-midwives, medical attendants, and ambulance drivers involved in maternity care.
  
  
  METHODS
  In March 2012, health care workers were trained in HMS BAB, a half-day simulation-based training, using a train-the-trainer model. The training focused on basic delivery care, active management of third stage of labor, and treatment of postpartum hemorrhage, including bimanual uterine compression.
  
  
  METHODS
  Evaluation questionnaires provided information on course perception. Knowledge, skills, and confidence of facilitators and learners were tested before and after training.
  
  
  RESULTS
  Four master trainers trained eight local facilitators, who subsequently trained 89 learners. After training, all facilitators passed the knowledge test, but pass rates for the skills test were low (29% pass rate for basic delivery and 0% pass rate for management of postpartum hemorrhage). Evaluation revealed that HMS BAB training was considered acceptable and feasible, although more time should be allocated for training, and teaching materials should be translated into the local language. Knowledge, skills, and confidence of learners increased significantly immediately after training. However, overall pass rates for skills tests of learners after training were low (3% pass rate for basic delivery and management of postpartum hemorrhage).
  
  
  CONCLUSIONS
  The HMS BAB simulation-based training has potential to contribute to education of health care providers. We recommend a full day of training and validation of the facilitators to improve the training.
authors.affiliation: Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania; Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Nelissen
authors.forename: Hege
authors.initials: H
authors.lastname: Ersdal
authors.forename: Doris
authors.initials: D
authors.lastname: Ostergaard
authors.forename: Estomih
authors.initials: E
authors.lastname: Mduma
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Broerse
authors.forename: Bjørg
authors.initials: B
authors.lastname: Evjen-Olsen
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: Jelle
authors.initials: J
authors.lastname: Stekelenburg
mesh_terms: D000328:Adult; D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000193:education*; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007749:Labor Stage, Third; D008348:Manikins; D008880:Midwifery / Q000193:education*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D015397:Program Evaluation; D012424:Rural Population; D011795:Surveys and Questionnaires; D013636:Tanzania; D013663:Teaching
keywords: Maternal mortality; Tanzania; clinical skills; education; knowledge; obstetrics; patient simulation; postpartum hemorrhage