The effect of providing resuscitation training to frontline staff on rates of maternal and trauma mortality in two health districts in Malawi.

Background and Goals Malawi has one of the highest maternal mortality rates in the world, between 8071 to 11202 maternal deaths per 100,000 live births, per year. Only 31% of children born to mothers who die in the peri-partum period survive infancy3. It is Malawian government policy to actively encourage women to deliver in either health centres or hospitals with a skilled attendant. However a considerable number of women still deliver in villages with no skilled attendant. Malawi, in common with much of Africa, also has a very high Road Traffic Accident fatality rate at 26 deaths per 100,000 inhabitants per year; the comparable figure for The Netherlands is 4.1.4 A district hospital usually only has 1-2 doctors on staff, a health centre none. Care is provided by nurse midwives or medical assistants (three years training) or clinical officers (four years training). The three day High Dependency, Obstetrics and Trauma management (HOT) training program evolved over a number of years to provide knowledge and skills to first responders at health centre and district hospital level. The course focuses on effective management of women with obstetric emergencies and also trauma patients, especially road traffic accident (RTA) victims. The course has been run sixteen times since 2005 and a total of 391 health care workers have successfully completed training. We set out to evaluate whether this training has impacted on care and maternal (MMR) and trauma (TMR) mortality rates.