The effect of smartphone training of Ghanaian midwives by the Safe Delivery application on the incidence of postpartum hemorrhage: A cluster randomised controlled trial

Objective: To assess the impact on postpartum hemorrhage (PPH) of a smartphone training application called “Safe Delivery”, distributed to midwives. Design: A cluster randomized controlled trial. Setting: Greater Accra Region, Ghana. Population: 146 midwives were randomly allocated to intervention (70 midwives, seven hospitals, 1,665 deliveries) or control (76 midwives, eight hospitals, 1,746 deliveries). Methods: The intervention group received Safe Delivery which is a smartphone training tool in Emergency Obstetric and Neonatal Care. Main Outcome Measures: The primary outcome was PPH. Secondary outcomes were severe PPH and the relative difference in postpartum blood loss. Results: The intervention was associated with an insignificant lower incidence of PPH (odds ratio 0.86 (95% confidence interval (CI) 0.59 to 1.25)) and an insignificant lower incidence of severe PPH: odds ratio.95 (95% CI:.65 to 1.40). The relative difference in blood loss between intervention and control arms was: 5.3% (95% CI: −3.2%, to13.8%). The intra-class correlation for hospitals was.016, and for midwives within hospitals:.026. Conclusions: Safe Delivery was associated with an insignificant lower incidence of PPH. The validity of the blood loss data was a concern since the data collection was not completely uniformly and this imprecision could not be evaluated. The study questions whether Safe Delivery works as a stand-alone tool to improve basic emergency obstetric and neonatal care.