BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.
Background: There is an unmet need for in-service training of health providers for essential newborn care. This study evaluated the ability of a multi-modal training workshop on newborn care to improve the knowledge and skills of health providers. Methods: This was an intervention based pre-and post-study on 54 students who attended a two-day workshop on essential newborn care. The teaching used self-directed learning, demonstration, videos, webinars, podcasts, group discussion, role-play and individual feedback. Knowledge was assessed by a set of 25 peer-reviewed multiple-choice questions (MCQs), both pre-and post-test and skills by 3 peer-reviewed and validated objective structured clinical examination (OSCE) stations in the post-test period. Follow-up assessment after 10 months was also done for 30 students. Results: There was a significant improvement in the knowledge scores on MCQs after the workshop [ 8 6 _ T D $ D I F F ] [16.65 AE 1.84 vs 12 AE 2.98, mean difference 4.65, 95%CI (3.85 to 5.44); p value[ 8 7 _ T D $ D I F F ] < 0.0001]. The skill scores assessed by the OSCE were 92.35%, 83.50% and 78.86% of the expected scores respectively with a composite OSCE stations score of 83.90% of the expected score (100%). Follow-up assessment after 10 months showed a significant decline in knowledge scores, though skill scores were retained. Conclusion: An essential newborn care workshop using multi-modal teaching methods resulted in an improvement in knowledge and skill scores among a diverse mix of nurses and doctors. This model of learning was acceptable and can be adapted for future training of health providers. There is a need for regular refresher training to maintain knowledge and skills.
We read with great interest the article "Hyperglycaemia as a risk factor for the development of retinopathy of prematurity: A cohort study" by Vannadil et al., published in Medical Journal Armed Forces India 2020. 76; 95e102. 1 The study concludes that journal homepage: www .e lsev ie r. co m/ lo cate/ mj afi m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 6 ( 2 0 2 0 ) 4 8 0 e4 8 1
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