Study problem: Maternal death rates in the South remain high, figures ranging from 0.8% (Africa, Cambodia) to 1.6% (Afghanistan) compared to estimated 24/100,000 for Europe. Corresponding death rates for newborn are 8 - 10 times as high. Previous interven tions to reduce mortality have had in common that expatriate/city-based experts set standards for local midwifery that neither apply to the account of reality as seen by traditional village birth attendants; nor do the treatment guidelines address the hea viest risk factors - such as, what to do with bleeding wombds?
Strategy: The actual study draws on lessons from post-revolutionary Malaysia - lessons obviously forgotten - where indigenous interdisciplinary capacity building reduced maternal mortality ra tes from 2.1% to 0.3% from 1947 - 57. In this prospective study we are merging an already existing and highly efficient rural trauma system in Northwestern Cambodia with the rural midwifery network. The trainers will be trauma paramedics, living and worki ng inside the mine fields. Det delivery life support training will be done at "Village Universities" (makeshift rural training centers) under the slogan "Khmer teaching Khmer". The delivery life support protocol corresponds to the trauma life support prot ocol and delegates life-saving skills from the district hospitals to village care providers.
Study design: Mortality data for mothers and newborn will be gathered during the training period (phase 1) to get a solid historical baseline to estimate the eff ect of a two-year intervnetion (phase 2).
Applicability: If successful, the Cambodian health authorities will apply this integrated approach nation-wide. Also TMC will test the model in other settings in the rural South.