Evaluation of Maternal and Newborn Health Simulation Labs in Seven Referral Hospitals in Nepal to Improve Care for Postpartum Hemorrhage and Birth Asphyxia

What this Trial Is About

Postpartum hemorrhage and birth asphyxia are leading causes of death for mothers and newborns worldwide, especially in low and middle-income countries. While Nepal has improved maternal and neonatal health, gaps remain in healthcare providers knowledge and skills, likely due to limited practical experience. This study evaluates the implementation and effectiveness of simulation-based training centers in seven referral hospitals in Nepal to improve care for labor, bleeding after birth, and newborn resuscitation using a RE-AIM framework and a quasi-experimental pre- and post-test design. The project establishes high-fidelity simulation labs with multiple rooms and equipment in each hospital, providing training focused on Essential Care for Labor and Birth, Bleeding after Birth, and Helping Babies Breathe modules. Training is given to maternal and newborn health staff, including trainers and simulation lab operators. The intervention group receives this training after an initial pre-test phase. Data collection on maternal and neonatal health outcomes continues throughout pre-test, intervention, and post-test phases. Participants include women delivering vaginally, their newborns, and healthcare providers in the selected hospitals. Data collected include postpartum hemorrhage incidence, neonatal APGAR scores at 5 minutes, and blood transfusion rates after hemorrhage. Skills and team performance of providers are assessed before and six months after training. Qualitative interviews and focus groups explore challenges and implementation status. The study uses daily data collection and statistical analyses, with a total participation duration of about 15 months for outcome monitoring and six months for skill assessment.

Evaluation of Maternal & Newborn Health Simulation Lab Centers of Excellence in Nepal