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Effects of the Helping Mothers Survive Bleeding after Birth training on near miss morbidity and mortality in Uganda: A cluster‐randomized trial
Author(s) -
Hanson Claudia,
Atuhairwe Susan,
Lucy Atim Joyce,
Marrone Gaetano,
Morris Jessica L.,
Kaharuza Frank
Publication year - 2021
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13395
Subject(s) - medicine , case fatality rate , randomized controlled trial , interrupted time series analysis , cluster (spacecraft) , cluster randomised controlled trial , demography , significant difference , near miss , pediatrics , obstetrics , population , surgery , environmental health , statistics , mathematics , forensic engineering , sociology , computer science , engineering , programming language
Objective To assess the effect of Helping Mothers Survive Bleeding after Birth training on postpartum hemorrhage (PPH) near miss and case fatality rates in Uganda. Methods Training was evaluated using a cluster‐randomized design between June 2016 and September 2017 in 18 typical rural districts (clusters) in Eastern and Central Uganda of which nine districts were randomly assigned to the intervention. The main outcome was PPH near miss defined using the World Health Organization’s disease and management‐based approach. Interrupted time series analysis was performed to estimate the difference in the change of outcomes. Results Outcomes of 58 000 and 95 455 deliveries during the 6‐month baseline and 10‐month endline periods, respectively, were included. A reduction of PPH near misses was observed in the intervention compared to the comparison districts (difference‐in‐difference of slopes 4.19, 95% CI, –7.64 to –0.74); P <0.05). There was an increase in overall reported near miss cases (difference‐in‐difference 1.24, 95% CI, 0.37–2.10; P <0.001) and an increase in PPH case fatality rate (difference‐in‐difference 2.13, 95% CI, 0.14–4.12; P <0.05). Conclusion This pragmatic cluster‐randomized trial conducted in typical rural districts of Uganda indicated a reduction of severe PPH cases while case fatality did not improve, suggesting that this basic training needs to be complemented by additional measures for sustained mortality reduction. Trial registration: PACTR201604001582128.