2026-08-26 カロリンスカ研究所（KI）
＜関連情報＞
- https://news.ki.se/improved-maternity-care-linked-to-fewer-deaths
- https://www.nature.com/articles/s41591-026-04599-w
サハラ以南アフリカにおける分娩期ケアのための多面的な病院ベースの介入：段階的クラスターランダム化試験 A multi-faceted hospital-based intervention for intrapartum care in sub-Saharan Africa: a stepped-wedge cluster-randomized trial
Claudia Hanson,Joseph Akuze,Kristi Sidney Annerstedt,Helle Mölsted Alvesson,Sunjuri Sun,Manuela Straneo,Nicola Orsini,Lenka Benova,Mechthild M. Gross,Bruno Marchal,Rian Snijders,Effie Chipeta,Peter Waiswa,Hussein Kidanto,Jean-Paul Dossou,Andrea Barnabas Pembe & the ALERT Consortium
Nature Medicine Published:26 August 2026
DOI:https://doi.org/10.1038/s41591-026-04599-w
Abstract
Around three million babies are stillborn or die shortly after birth each year worldwide, underscoring a persistent and unacceptable burden on families and health systems. To help address this challenge, we developed the facility-based, multi-faceted Action Leveraging Evidence to reduce perinatal Mortality and Morbidity (ALERT) intervention. ALERT promoted essential practices of intrapartum childbirth using (i) co-design, (ii) training, (iii) quality improvement and (iv) leadership mentoring. We evaluated ALERT using a stepped-wedge cluster-randomized trial with five 6-month periods across 16 hospitals in Benin, Malawi, Tanzania and Uganda. Among 134,630 women (including 139,300 neonates), the intervention was associated with 22% lower odds of the composite co-primary outcome, early perinatal mortality, defined as fresh stillbirth and 24 h neonatal mortality (adjusted odds ratio 0.78, 95% confidence interval 0.65–0.94), but not with the co-primary outcome, fresh stillbirth (adjusted odds ratio 0.88, 95% confidence interval 0.68–1.13). Despite the limitation of only including 16 hospitals, the diversity of settings across four sub-Saharan African countries supports the finding that early perinatal mortality and morbidity could be reduced through implementation of multi-faceted, context-specific strategies to build maternity provider capacities. Pan African Clinical Trial Registry: 202006793783148.
