title: Impact of a low-technology simulation-based obstetric and newborn care training scheme on non-emergency delivery practices in Guatemala.
abstract: OBJECTIVE
  To assess the effect of a low-technology simulation-based training scheme for obstetric and perinatal emergency management (PRONTO; Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) on non-emergency delivery practices at primary level clinics in Guatemala.
  
  
  METHODS
  A paired cross-sectional birth observation study was conducted with a convenience sample of 18 clinics (nine pairs of intervention and control clinics) from June 28 to August 7, 2013. Outcomes included implementation of practices known to decrease maternal and/or neonatal mortality and improve patient care.
  
  
  RESULTS
  Overall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labor was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams (P=0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams (P<0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams (P=0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams (P=0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites (P=0.012).
  
  
  CONCLUSIONS
  Use of PRONTO enhanced non-emergency delivery care by increasing evidence-based practice, patient-centered care, and teamwork.
authors.affiliation: School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Walton
authors.affiliation: Epidemiological Research Center in Sexual and Reproductive Health, Guatemala City, Guatemala.
authors.forename: Edgar
authors.initials: E
authors.lastname: Kestler
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA. Electronic address: jcdettin@uw.edu.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dettinger
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Zelek
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Holme
authors.affiliation: Department of Obstetrics and Gynecology and Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Dilys
authors.initials: D
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000193:education*; D055317:Evidence-Based Practice / Q000592:standards*; D005260:Female; D006166:Guatemala; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D008880:Midwifery / Q000193:education*; D018802:Patient-Centered Care / Q000592:standards*; D011247:Pregnancy; D055815:Young Adult
keywords: Emergency obstetric and newborn care; Guatemala; Maternal mortality; Neonatal mortality; Skilled birth attendants; Training