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

Acta Obstet Gynecol Scand. 2012 May;91(5):593-7. doi: 10.1111/j.1600-0412.2012.01374.x. Epub 2012 Mar 29.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cluster Analysis
  • Cohort Studies
  • Female
  • Guatemala / epidemiology
  • Humans
  • Infant, Newborn
  • Male
  • Middle Aged
  • Midwifery / education*
  • Perinatal Care / standards*
  • Perinatal Mortality*
  • Pregnancy
  • Prospective Studies
  • Stillbirth / epidemiology
  • World Health Organization
  • Young Adult