The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study

Jolene N. Moore* (Corresponding Author), Wayne Morriss, Gebrehiwot Asfaw, Gosa Tesfaye, Aaliya R. Ahmed, Isabeau A. Walker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Reducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia. We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018. Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline (n = 101, 69% response rate). Pre- and post-course MCQs (n = 121, n = 123 respectively) and pre- and post-course skills tests (n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up (n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training (P < 0.0001) and skills test scores improved from 56.5% to 83.2% (P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3–11 months post-training compared to baseline (P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up. This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.
Original languageEnglish
Pages (from-to)297-305
Number of pages9
JournalAnaesthesia and Intensive Care
Issue number4
Publication statusPublished - 23 Aug 2020

Bibliographical note

The authors wish to thank the following people:

Dr Mahder Kinfe and Dr Tirunesh Busha, for assistance with follow-up data collection.

Dr Victoria White, for assistance with behavioural questionnaire data analysis.

The Amhara and Tigray Regional Health Bureaus, Ethiopian Society of Anaesthesiologists, Ethiopian Association of Anaesthetists, the Federal Ministry of Health of Ethiopia and Assist International for their support with running the SAFE-OB courses.

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The SAFE courses and follow-up evaluation in this study were funded by GE Foundation.


  • Anaesthesia
  • anaesthetists
  • Ethiopia
  • obstetric
  • training


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