title: One-year evaluation of the impact of an emergency obstetric and neonatal care training program in Western Kenya.
abstract: OBJECTIVE
  To determine the impact of introducing an emergency obstetric and neonatal care training program on maternal and perinatal morbidity and mortality at Moi Teaching and Referral Hospital, Eldoret, Kenya.
  
  
  METHODS
  A prospective chart review was conducted of all deliveries during the 3-month period (November 2009 to January 2010) before the introduction of the Advances in Labor and Risk Management International Program (AIP), and in the 3-month period (August-November 2011) 1 year after the introduction of the AIP. All women who were admitted and delivered after 28 weeks of pregnancy were included. The primary outcome was the direct obstetric case fatality rate.
  
  
  RESULTS
  A total of 1741 deliveries occurred during the baseline period and 1812 in the postintervention period. Only one mother died in each period. However, postpartum hemorrhage rates decreased, affecting 59 (3.5%) of 1669 patients before implementation and 40 (2.3%) of 1751 afterwards (P=0.029). The number of patients who received oxytocin increased from 829 (47.6%) to 1669 (92.1%; P<0.001). Additionally, the number of neonates with 5-minute Apgar scores of less than 5 reduced from 133 (7.7%) of 1717 to 95 (5.4%) of 1745 (P=0.006).
  
  
  CONCLUSIONS
  The introduction of the AIP improved maternal outcomes. There were significant differences related to use of oxytocin and postpartum hemorrhage.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Toronto, Toronto, ON, Canada. Electronic address: rspitzer@mtsinai.on.ca.
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Spitzer
authors.affiliation: Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada.
authors.forename: Sarah Jane
authors.initials: SJ
authors.lastname: Steele
authors.affiliation: Department of Obstetrics and Gynecology, The University of Toronto, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Caloia
authors.affiliation: Department of Obstetrics and Gynecology, The University of Toronto, Toronto, ON, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Thorne
authors.affiliation: Department of Obstetrics and Gynecology, The University of Toronto, Toronto, ON, Canada.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Bocking
authors.affiliation: Department of Obstetrics and Gynecology, The University of Toronto, Toronto, ON, Canada; Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Astrid
authors.initials: A
authors.lastname: Christoffersen-Deb
authors.affiliation: Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada.
authors.forename: Aaron
authors.initials: A
authors.lastname: Yarmoshuk
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Loise
authors.initials: L
authors.lastname: Maina
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Johanna
authors.initials: J
authors.lastname: Sitters
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chemwolo
authors.affiliation: Department of Obstetrics and Gynaecology, Moi University, Eldoret, Kenya.
authors.forename: Elkanah
authors.initials: E
authors.lastname: Omenge
mesh_terms: D000328:Adult; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008428:Maternal Mortality; D008485:Medical Audit; D009774:Obstetrics / Q000193:education*; D054238:Perinatal Mortality; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
keywords: Emergency obstetric and neonatal care (EmONC); Evaluation; Maternal morbidity; Maternal mortality; Obstetrics; Training