Intervention
PPH
RETAINED PLACENTA
The SDA is a BEmONC training aid developed by two researchers from University of Southern Denmark and University of Copenhagen (second and last author), the non-governmental organization Maternity Foundation and Visikon, a private company specialized in visual health information. The app contained four cartoon videos lasting four to eight minutes about active management of the third stage of labour to prevent PPH, the management of manifest PPH, the removal of a retained placenta and neonatal resuscitation (Fig. The Safe Delivery App. Printed with permission from Maternity FoundationThe films had a dual language function, either English (the working language at the health facilities) or the local language Oromiffa. It also had a list of essential drugs and a list of basic equipment. Every day the user received notifications to encourage the use of the app. The app had a tracking function where the use of the different content was registered with GPS coordinates. Smart phones with the SDA preloaded including charger and earphones were provided for the health providers in the intervention group. A half-day introduction to the use of the phone and the app was given. This however did not include clinical skills training of any kind. Participants were strictly asked not to share or show the app to other health providers from other health facilities. Beforehand health facilities were assured to have basic equipment and drugs.After this trial a full version of the app has been developed including all seven BEmONC signal functions which can be downloaded for free at (Participants’ skills and knowledge were assessed at baseline and at 6- and 12-months follow-up. The skills and knowledge tests were performed by two research assistants, both experienced Ethiopian midwives, who were trained in performing test-scores in structured role-play scenarios with the aid of a pelvic, uterine and neonatal mannequin and a selection of relevant equipment and drugs. One directed the scenario while the other did the observation and scoring. The PPH scenario lasted 10–15 min and was the same for all tested persons. After the scenario, the two research assistants would go through the scoring and agree for each item. The knowledge test was performed on the same day as the skills test. It took place in a classroom setting with no access to any aid and took approximately 1 h. There was an option to have it in English or Oromiffa.