ABSTRACT
OBJECTIVE: To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries. METHODS: Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania. RESULTS: In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved. CONCLUSION: In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuum-assisted vaginal delivery increased in frequency after ALSO training.
Subject(s)
Developing Countries , Life Support Care/methods , Obstetrics/education , Program Evaluation/statistics & numerical data , Adult , Colombia , Delivery, Obstetric/trends , Female , Guatemala , Honduras , Hospital Mortality/trends , Humans , Longitudinal Studies , Maternal Mortality/trends , Near Miss, Healthcare/trends , Postpartum Hemorrhage/mortality , Pregnancy , Prospective Studies , TanzaniaABSTRACT
BACKGROUND: The Advanced Life Support in Obstetrics (ALSO) program helps pregnancy care providers learn the information and skills necessary to deal with urgent and emergent conditions that arise during pregnancy and delivery by using mannequins, mnemonics, and evidence-based approaches. Since its origin, the program has been disseminated internationally. Outside of North America, more than 18,000 clinicians have taken the ALSO course, and more than 1,200 ALSO individuals have been approved as ALSO instructors. Some of the international programs have become self-sustaining, others have not. METHODS: Features of ALSO programs were analyzed in all countries in which ALSO has been introduced to identify characteristics associated with the program becoming self-sustaining. RESULTS: Characteristics of self-sustaining ALSO programs include a strong organizational structure, use of a train-the-trainer model to introduce the course, and encouragement of competing groups to work together. Overall, the program has been sustained by drawing on the expertise of international collaborators for medical content and by balancing customization of content against preservation of core information and skills. CONCLUSIONS: When the ALSO program is introduced to a new country or region, methods that have resulted in programs becoming self-sustaining should be used.
Subject(s)
Advanced Cardiac Life Support/education , Education/organization & administration , International Cooperation , Obstetrics , Curriculum , Female , Humans , Professional CompetenceABSTRACT
BACKGROUND: The Advanced Life Support in Obstetrics (ALSO) program is a highly structured, evidence-based, two-day course designed to provide healthcare professionals with the knowledge and skills to manage the emergency conditions that can occur during childbirth. OBJECTIVES: To document the number of ALSO-trained clinicians and instructors in the United States and internationally and to promote ALSO training among prehospital and disaster medicine professionals. METHODS: Records maintained by the American Academy of Family Physicians (AAFP) for each country where ALSO is taught were reviewed for: (1) the years and locations of the ALSO courses; (2) the number of ALSO-trained caregivers; and (3) the number of ALSO instructors. RESULTS: Between 1991 and 2005, 54,071 ALSO-trained caregivers and 2,251 instructors have completed provider and instructor ALSO courses in 25 countries. Of these, 17,755 caregivers and 1,220 instructors are from outside the United States. CONCLUSION: The ALSO program is a popular, multi-disciplinary course for preparing maternity caregivers to manage obstetric emergencies. Limited evidence suggests it can be effective and efficient in enhancing the knowledge and skills of prehospital and disaster medicine clinicians. Hong Kong provides a model in which emergency physicians have taken the lead in promoting the ALSO course. As the ALSO program expands, additional research is needed to assess its impact on educational and health outcomes.