Hector Lamadrid-Figueroa | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Introduction: The majority of maternal deaths in Mexico occur within health facilities, often attributable to suboptimal care and lack of access to emergency services. Improving obstetric and neonatal emergency care can improve health outcomes. We evaluated the impact of PRONTO, a simulation-based low-cost obstetric and neonatal emergency and team training program on patient outcomes.

Methods: We conducted a pair-matched hospital-based quasi-experimental trial in Mexico from 2010 – 2013 with 24 public hospitals. Obstetric and neonatal care providers participated in PRONTO trainings at intervention hospitals. Control hospitals received no intervention. Outcome measures included hospital-based neonatal mortality, maternal complications, and cesarean delivery. We fitted mixed effects negative binomial regression models using a difference-in-differences approach to estimate incidence rate ratios (IRR) and 95% confidence intervals cumulatively and at follow-up intervals measured at four, eight, and 12 months.

Results:  Neonatal mortality risk did not differ cumulatively post-intervention, but it was 40% lower in intervention hospitals at eight months post-intervention (IRR: 0.60, p=0.03). Risk of cesarean was significantly lower in intervention hospitals during all 12 months cumulative of follow-up (IRR 0.79, p=0.005), and for intervals measured at four (IRR 0.84, p=0.02), eight (IRR 0.80, p=0.004), and 12 (IRR 0.80, p=0.003) months follow-up. Risk of maternal complications did not differ significantly.