{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:20:05Z","timestamp":1792887605699,"version":"4.5.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T00:00:00Z","timestamp":1623801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia &amp;amp; eclampsia (PE&amp;amp;E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016\u2013August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents\/interns, nurses, students, and \u201cother.\u201d A significant improvement in knowledge scores was observed for both the BAB and PE&amp;amp;E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&amp;amp;E virtual training pilot workshop in August 2020.<\/jats:p><jats:p><jats:bold>Discussion\/Conclusions:<\/jats:bold> Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&amp;amp;E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.<\/jats:p>","DOI":"10.3389\/fpubh.2021.660908","type":"journal-article","created":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T08:02:35Z","timestamp":1623830555000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Helping Mothers Survive: Program Evaluation and Early Outcomes of Maternal Care Training in the Dominican Republic"],"prefix":"10.3389","volume":"9","author":[{"given":"Meghan","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Leader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanny","family":"Roa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ericka","family":"Jaramillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davina","family":"Lazala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Flores","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Cadet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turaj","family":"Vazifedan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Bentley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,16]]},"reference":[{"key":"B1","unstructured":"Maternal Mortality2019"},{"key":"B2","unstructured":"MDG 5: Improve Maternal Health.2020"},{"key":"B3","unstructured":"UnitedNations\n          33870681Sustainable Development Goal 3: Ensure Healthy Lives and Promote Well-Being for All Ages2020"},{"key":"B4","unstructured":"Maternal Mortality Ratio (per 100,000 live births), Data by Region: Latin America and the Caribbean2020"},{"key":"B5","unstructured":"Maternal Mortality Ratio (per 100,000 live births), Data by Country: Dominican Republic2020"},{"key":"B6","unstructured":"Direcci\u00f3n General de Epidemiolog\u00eda: Weekly Epidemiological Bulletin2018"},{"key":"B7","unstructured":"UnitedNations Population Fund\n          Overview of the Situation of Maternal Morbidity and Mortality: Latin America and the Caribbean2017"},{"key":"B8","unstructured":"Births Attended by Skilled Health Staff (% of Total) - Dominican Republic2020"},{"key":"B9","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1186\/s12884-016-1141-3","article-title":"Helping babies breathe (HBB) training: what happens to knowledge and skills over time?","volume":"16","author":"Bang","year":"2016","journal-title":"BMC Pregnancy Childbirth."},{"key":"B10","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/ijn.12561","article-title":"Helping babies breathe implementation in Zanzibar, Tanzania","volume":"23","author":"Wilson","year":"2017","journal-title":"Int J Nurs Pract"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0207909","DOI":"10.1371\/journal.pone.0207909","article-title":"Peer-assisted learning after onsite, low-dose, high-frequency training and practice on simulators to prevent and treat postpartum hemorrhage and neonatal asphyxia: a pragmatic trial in 12 districts in Uganda","volume":"13","author":"Evans","year":"2018","journal-title":"PLoS ONE"},{"key":"B12","unstructured":"Training and Programming Materials2020"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e001214","DOI":"10.1136\/bmjgh-2018-001214","article-title":"Effect of the competency based Helping Mothers Survive Bleeding after Birth (HMS BAB) training on maternal morbidity: a cluster randomised trial in 20 districts in Tanzania","volume":"4","author":"Alwy","year":"2019","journal-title":"BMJ Glob Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s12884-017-1481-7","article-title":"Clinical performance and patient outcome after simulation-based training in prevention and management of postpartum haemorrhage: an educational intervention study in a low-resource setting","volume":"17","author":"Nelissen","year":"2017","journal-title":"BMC Pregnancy Childbirth."},{"key":"B15","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/aogs.12321","article-title":"Helping mothers survive bleeding after birth: an evaluation of simulation-based training in a low-resource setting","volume":"93","author":"Nelissen","year":"2013","journal-title":"Acta Obstet Gynecol Scand."},{"key":"B16","doi-asserted-by":"publisher","first-page":"457","DOI":"10.9745\/GHSP-D-19-00124","article-title":"Management of preeclampsia, severe preeclampsia, and eclampsia at primary care facilities in Bangladesh","volume":"7","author":"Williams","year":"2019","journal-title":"Glob Health Sci Pract."},{"key":"B17","unstructured":"EvansCL\n            FitzgeraldL\n          Helping Mothers Survive Bleeding After Birth Complete2017"},{"key":"B18","unstructured":"Partnerships and Programs2020"},{"key":"B19","unstructured":"EvansCL\n            FitzgeraldL\n          Helping Mothers Survive Preeclampsia & Eclampsia2017"},{"key":"B20","unstructured":"COVID-19 Situation Reports: March\u2013April 20202020"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.660908\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T08:02:39Z","timestamp":1623830559000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.660908\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,16]]},"references-count":20,"alternative-id":["10.3389\/fpubh.2021.660908"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.660908","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,16]]},"article-number":"660908"}}