PLoS ONE
Volume 11, Issue 10, 2016

Accelerated training of skilled birth attendants in a marginalized population on the Thai-myanmar border: A multiple methods program evaluation (Article) (Open Access)

White A.L. , Min T.H. , Gross M.M. , Kajeechiwa L. , Thwin M.M. , Hanboonkunupakarn B. , Than H.H. , Zin T.W. , Rijken M.J. , Hoogenboom G. , McGready R.
  • a Pregnancy Research Centre, Royal Women's Hospital, Melbourne, Australia
  • b Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • c Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
  • d Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • e Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • f Mahidol-Oxford Tropical Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  • g Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • h Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • i Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand, Julius Global Health and Department of Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands
  • j Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
  • k Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand, Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom

Abstract

Background To evaluate a skilled birth attendant (SBA) training program in a neglected population on the Thai-Myanmar border, we used multiple methods to show that refugee and migrant health workers can be given effective training in their own environment to become SBAs and teachers of SBAs. The loss of SBAs through resettlement to third countries necessitated urgent training of available workers to meet local needs. Methods and Findings All results were obtained from student records of theory grades and clinical log books. Qualitative evaluation of both the SBA and teacher programs was obtained using semistructured interviews with supervisors and teachers. We also reviewed perinatal indicators over an eight-year period, starting prior to the first training program until after the graduation of the fourth cohort of SBAs. Results Four SBA training programs scheduled between 2009 and 2015 resulted in 79/88 (90%) of students successfully completing a training program of 250 theory hours and 625 supervised clinical hours. All 79 students were able to: achieve pass grades on theory examination (median 80%, range [70±89]); obtain the required clinical experience within twelve months; achieve clinical competence to provide safe care during childbirth. In 2010±2011, five experienced SBAs completed a train-the-trainer (TOT) program and went on to facilitate further training programs. Perinatal indicators within Shoklo Malaria Research Unit (SMRU), such as place of birth, maternal and newborn outcomes, showed no significant differences before and after introduction of training or following graduate deployment in the local maternity units. Confidence, competence and teamwork emerged from qualitative evaluation by senior SBAs working with and supervising students in the clinics. Conclusions We demonstrate that in resource-limited settings or in marginalized populations, it is possible to accelerate training of skilled birth attendants to provide safe maternity care. Education needs to be tailored to local needs to ensure evidence-based care of women and their families. © 2016 White et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Author Keywords

[No Keywords available]

Index Keywords

education Health Personnel curriculum maternal care birth refugee education program health care personnel Thailand human Refugees childbirth education Burmese Clinical Competence qualitative research Young Adult migrant worker Humans curriculum development semi structured interview female pregnancy Myanmar Article program evaluation adult skilled birth attendant Parturition maternal health service Maternal Health Services paramedical personnel
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84991241523&doi=10.1371%2fjournal.pone.0164363&partnerID=40&md5=87fba213e6a5d5ba7df4666440587938
DOI: 10.1371/journal.pone.0164363
ISSN: 19326203
Cited by: 8
Original Language: English