title: Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe.
abstract: OBJECTIVE
  In Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths.
  
  
  METHODS
  We established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital.
  
  
  METHODS
  Maternal mortality in Zimbabwe has increased from 555 to 960 per 100,000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff.
  
  
  RESULTS
  Following an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014.
  
  
  CONCLUSIONS
  Introducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England .
authors.forename: Joanna F
authors.initials: JF
authors.lastname: Crofts
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Teclar
authors.initials: T
authors.lastname: Mukuli
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Bobb T
authors.initials: BT
authors.lastname: Murove
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Solwayo
authors.initials: S
authors.lastname: Ngwenya
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Sma
authors.initials: S
authors.lastname: Mhlanga
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Meluleki
authors.initials: M
authors.lastname: Dube
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Elton
authors.initials: E
authors.lastname: Sengurayi
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England .
authors.forename: Cathy
authors.initials: C
authors.lastname: Winter
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England .
authors.forename: Sharon
authors.initials: S
authors.lastname: Jordan
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England .
authors.forename: Sonia
authors.initials: S
authors.lastname: Barnfield
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England .
authors.forename: Heather
authors.initials: H
authors.lastname: Wilcox
authors.affiliation: School of Clinical & Experimental Medicine, Birmingham Women's Hospital Foundation Trust, Birmingham, England .
authors.forename: Abi
authors.initials: A
authors.lastname: Merriel
authors.affiliation: Morriston Hospital, Swansea, Wales .
authors.forename: Sabelo
authors.initials: S
authors.lastname: Ndlovu
authors.affiliation: Royal Glamorgan Hospital, Cardiff, Wales .
authors.forename: Zedekiah
authors.initials: Z
authors.lastname: Sibanda
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Sikangezile
authors.initials: S
authors.lastname: Moyo
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe .
authors.forename: Wedu
authors.initials: W
authors.lastname: Ndebele
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS10 5NB, England .
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Draycott
authors.affiliation: Bay of Plenty District Health Board, Whakatane Hospital, Whakatane, New Zealand .
authors.forename: Thabani
authors.initials: T
authors.lastname: Sibanda
mesh_terms: D002983:Clinical Competence; D004501:Education, Medical / Q000191:economics / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality; D008880:Midwifery / Q000193:education*; D010820:Physicians; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D016896:Treatment Outcome; D015030:Zimbabwe / Q000453:epidemiology