Effects of the HMS BAB training on primary and secondary indicators using interrupted time series analysis
| Outcome | Baseline indicator estimate (comparison) n/% (95% CI) | Baseline trend (comparison) | Short-term effect difference between intervention and comparison district | Long-term effect difference between intervention and comparison district |
| Primary indicators | Estimate (95% CI) | |||
| All-cause near misses among all women who delivered in a facility | 1059 6.3% (4.5% to 8.2%) | 0.1 (−0.3 to 0.4) | −1.5 (−2.4 to 2.1) | −0.3 (−1.0 to 0.3) |
| PPH near misses among all women who delivered in a facility | 278 1.7% (1.1% to 2.3%) | −0.1 (−0.2 to 0.1) | −1.3 (−2.4 to −0.11)* | −0.3 (−0.7 to 0.1) |
| PPH near misses among women who suffered PPH during health facility delivery | 278 70.1% (60.2% to 80.0%) | −3.2 (−5.1 to −1.3) | −20.1 (−33.1 to −7.0)* | −5.3 (−7.8 to −2.7)*** |
| Secondary indicators | ||||
| PPH cases of all deliveries | 411 2.5% (1.7% to 3.3%) | 0.0 (−0.2 to 0.2) | −0.8 (−2.6 to 1.0) | −0.3 (−0.8 to 0.2) |
| Deaths/case fatality in PPH near miss cases | 8 3.4% (0.4% to 6.4%) | −2.0 (−3.1 to −1.0)** | −9.3 (−21.0 to 2.4) | −4 to 0 (−6.5 to −1.5)** |
| AMTSL | 334 81.5% (66.3% to 96.7%) | 1.2 (−0.2 to 2.6) | −3.5 (−14.1 to 7.1) | 2.0 (−0.9 to 4.9) |
| Women treated with intravenous oxytocin | 380 92.4% (88.6% to 96.2%) | 4.8 (1.2 to 8.3)* | 2.7 (−10.7 to 16.1) | 5.2 (1.4 to 8.9)** |
| Women with Hb <70 g/L before discharge | 58 18.4% (0.2% to 34.5%) | 0.2 (−0.8 to 1.3) | 1.4 (−10.6 to 7.8) | −0.8 (−2.7 to 1.1) |
| Women receiving BT | 257 63.4% (51.9% to 74.9%) | −2.5 (−6.1 to 0.9) | −22.1 (−42.2 to −2.1)* | −8.0 (−12.6 to −3.4)** |
| Removal of residuals of placenta | 154 35.5% (20.2% to 50.8%) | 1.2 (−0.9 to 3.3) | 8.9 (−8.9 to 26.7) | −1.8 (−5.9 to 2.3) |
| Women treated with hysterectomy | 18 5.4% (0% to 11%) | 3.2 (1.6 to 4.7)*** | 17.2 (11.2 to 23.1) | 3.3 (1.6 to 5.0) |
Significance level: *P<0.05; **P<0.001; ***P<0.0001.
Other PPH management interventions practised were balloon/catheter tamponade (13 cases, 1%), artery ligation (38 cases, 2%), abdominal packing (151 cases, 6%) and use of tranexamic acid in four cases. Only 5% of mothers received misoprostol as an alternate uterotonic drug (data not shown).
Values in bold present statistically significant changes *at <0.05, **at < 0.001 and *** at < 0.0001 significance level
AMTSL, active management of the third stage of labour; BT, blood transfusion; HMS BAB, Helping Mothers Survive Bleeding after Birth; PPH, postpartum haemorrhage.