Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality.

Academic Article


  • OBJECTIVES: To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes. DESIGN: Population-based, prospective, interventional pre-post design study. SETTING: 11 rural clusters in Chimaltenango, Guatemala. POPULATION: Health care providers. METHODS: This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006. OUTCOME MEASURES: The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g. RESULTS: Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57). CONCLUSION: Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability.
  • Authors


  • Adolescent, Adult, Aged, Aged, 80 and over, Cluster Analysis, Cohort Studies, Female, Guatemala, Humans, Infant, Newborn, Male, Middle Aged, Midwifery, Perinatal Care, Perinatal Mortality, Pregnancy, Prospective Studies, Stillbirth, World Health Organization, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Garcés A; McClure EM; Hambidge M; Krebs NF; Mazariegos M; Wright LL; Moore J; Carlo WA
  • Start Page

  • 593
  • End Page

  • 597
  • Volume

  • 91
  • Issue

  • 5