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. 2019 May 1;34(4):257-270.
doi: 10.1093/heapol/czz028.

The effectiveness of training in emergency obstetric care: a systematic literature review

Free PMC article

The effectiveness of training in emergency obstetric care: a systematic literature review

Charles A Ameh et al. Health Policy Plan. .
Free PMC article


Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before-after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.

Keywords: Emergency obstetric care; effectiveness; evaluation; health outcomes; newborn care; systematic review; training.


Figure 1
Figure 1
PRISMA flow diagram for systematic review of emergency obstetric care training packages.
Figure 2
Figure 2
Geographical distribution of studies.
Figure 3
Figure 3
Change in knowledge and skills calculated by pre-training score.

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    1. Ameh C, Adegoke A, Hofman J. et al. 2012. The impact of emergency obstetric care training in Somaliland, Somalia. International Journal of Gynecology & Obstetrics 117: 283–7. - PubMed
    1. Ameh CA, Kerr R, Madaj B. et al. 2016. Knowledge and skills of healthcare providers in Sub-Saharan Africa and Asia before and after competency-based training in emergency obstetric and early newborn care. PLoS One 11: e0167270.. - PMC - PubMed
    1. Ameh CA, van den Broek N.. 2015. Making it happen: training healthcare providers in emergency obstetric and newborn care. Best Practice & Research: Clinical Obstetrics & Gynaecology 29: 1077–97. - PubMed
    1. Ameh CA, White S, Dickinson F, Mdegela M, Madaj B, van den Broek N.. 2018. Retention of knowledge and skills after Emergency Obstetric Care training: a multicountry longitudinal study. PLoS One 13: e0203606. Doi: 10.1371/journal.pone.0203606. - PMC - PubMed

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