While Malawi has made great strides increasing the number of facility-based births, maternal and neonatal mortality remains high. An intervention started in 2019 provided short-course training followed by year-long longitudinal bedside mentorship for nurse midwives at seven health facilities in Blantyre district. The intervention was initiated following invitation from the district to improve outcomes for patients during childbirth. This study examined the impact of the intervention on the reporting of obstetric and neonatal complications and related care. Patient level data were collected from the District Health Information System 2 database from intervention and non-intervention facilities. Bivariate analysis explored the impact of longitudinal bedside mentorship on select District Health Information System 2 variables at six-month intervals. Outcomes were then analyzed using nonlinear quantile mixed models to better account for the impact of time and clustering at the facility level. Significant changes were found in the reporting of obstetric and neonatal complications over time at intervention facilities compared to non-intervention facilities. Intervention facilities showed statistically significant increases in the reporting of prolonged labor, pre/eclampsia, fetal distress, retained placenta, and premature labor. There was also a statistically significant decrease in the reporting of no complications in the multivariate model (95%CI: −0.8 to −0.2). In both the bivariate and multivariate models, the reporting of ‘None’ significantly decreased (0.8 % median), while the reporting of prematurity (0.2 % median) and asphyxia (0.3 % median) both significantly increased. The missingness of data at intervention facilities decreased to almost zero compared to non-intervention facilities. The increase in reported maternal and neonatal complications suggests improved early identification of complications at the facility level. The improved accuracy of patient data from intervention facilities shows the impact mentorship has on data quality which is crucial for the allocation of resources. By highlighting the apparent dose–response relationship of longitudinal bedside mentorship, this study will inform the broader use of mentorship in training programs. Future research is needed to explore the impact of longitudinal mentorship on quality of care.

中文翻译：

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评估马拉维布兰太尔地区初级卫生机构孕产妇和新生儿并发症的临床指导干预措施：全球护理行动计划的纵向分析


尽管马拉维在增加设施分娩数量方面取得了长足进步，但孕产妇和新生儿死亡率仍然很高。 2019 年开始的一项干预措施为布兰太尔区七个卫生机构的护士助产士提供短期培训，然后提供为期一年的纵向床边指导。该干预措施是应该地区的邀请启动的，旨在改善分娩期间患者的结局。这项研究探讨了干预措施对产科和新生儿并发症及相关护理报告的影响。患者水平数据是从干预和非干预设施的地区卫生信息系统 2 数据库中收集的。双变量分析探讨了纵向床边指导对每六个月一次的选定地区卫生信息系统 2 变量的影响。然后使用非线性分位数混合模型对结果进行分析，以更好地解释时间和集群在设施层面的影响。与非干预设施相比，随着时间的推移，干预设施的产科和新生儿并发症的报告发生了显着变化。干预设施显示，产程延长、先兆子痫、胎儿窘迫、胎盘滞留和早产的报告数量显着增加。多变量模型中无并发症的报告也有统计学上的显着下降（95％CI：-0.8至-0.2）。在双变量和多变量模型中，“无”的报告显着减少（中位数 0.8%），而早产（中位数 0.2%）和窒息（中位数 0.3%）的报告均显着增加。 与非干预设施相比，干预设施的数据缺失几乎为零。报告的孕产妇和新生儿并发症的增加表明，机构层面对并发症的早期识别有所改善。干预设施患者数据准确性的提高表明指导对数据质量的影响，这对于资源分配至关重要。通过强调纵向床边指导的明显剂量反应关系，这项研究将为在培训项目中更广泛地使用指导提供信息。未来的研究需要探索纵向指导对护理质量的影响。