Abstract:Background
The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool focusing on essential care to improve quality of intrapartum care. We aimed to assess the impact of an intervention package using the SCC tool on facility-based stillbirths (SBs) and very early neonatal deaths (vENDs), in Rajasthan, India.
Methods
Within a quasi-experimental framework, districts were selected as intervention or comparison, matched by annual delivery load. The SCC tool w… Show more
“…This early blood pressure check ensures early identi cation and management, thus prevents deterioration to severe pre-eclampsia/eclampsia. This view is validated by the quasi-experimental study [26] done in Rajasthan, India, which observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identi cation, management and timely referral of cases of pre-eclampsia [26].…”
Section: Discussionmentioning
confidence: 65%
“…This view is validated by the quasi-experimental study [26] done in Rajasthan, India, which observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identi cation, management and timely referral of cases of pre-eclampsia [26]. Though, the Better-Birth study, a clusterrandomized, controlled trial in Uttar Pradesh, India, found no signi cant impact of the SCC intervention on maternal morbidity or mortality [27], unavailability of medications and consumables may have been responsible.…”
Background: Safe childbirth remains a daunting challenge, particularly in low middle-income countries, where most pregnancy-related deaths occur. Cameroon's maternal mortality rate, estimated at 529 per 100,000 live births in 2017 is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. It was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods: A retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, post-partum haemorrhage) and neonatal (foetal death, neonatal asphyxia and neonatal death) complications. Data was collected six months after the introduction of the SCC at the maternity. The Chi-square test was used to compare categorical variables, while the student's T-test was used to compare continuous variables. Results: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, checklists were used in 828 of 976 clinical notes, giving a mean adoption rate of 84.8% and utilization rate of 93.9% at six months. Severe pre-eclampsia/eclampsia were associated with the non-use of SCC (2.1% Vs 5.4%, p = 0.017). Stillbirth, neonatal asphyxia, and neonatal death rates were not statistically different between checklist and non-checklist groups. However, in all neonatal outcomes, the proportion of complications was less when the checklist was used.Conclusion: The use of the safe childbirth checklist was associated with significantly reduced pregnancy complications, especially reducing severe pre-eclampsia/ and eclampsia. The use of the safe childbirth checklist increased to 93.9% of all deliveries within six months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.
“…This early blood pressure check ensures early identi cation and management, thus prevents deterioration to severe pre-eclampsia/eclampsia. This view is validated by the quasi-experimental study [26] done in Rajasthan, India, which observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identi cation, management and timely referral of cases of pre-eclampsia [26].…”
Section: Discussionmentioning
confidence: 65%
“…This view is validated by the quasi-experimental study [26] done in Rajasthan, India, which observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identi cation, management and timely referral of cases of pre-eclampsia [26]. Though, the Better-Birth study, a clusterrandomized, controlled trial in Uttar Pradesh, India, found no signi cant impact of the SCC intervention on maternal morbidity or mortality [27], unavailability of medications and consumables may have been responsible.…”
Background: Safe childbirth remains a daunting challenge, particularly in low middle-income countries, where most pregnancy-related deaths occur. Cameroon's maternal mortality rate, estimated at 529 per 100,000 live births in 2017 is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. It was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods: A retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, post-partum haemorrhage) and neonatal (foetal death, neonatal asphyxia and neonatal death) complications. Data was collected six months after the introduction of the SCC at the maternity. The Chi-square test was used to compare categorical variables, while the student's T-test was used to compare continuous variables. Results: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, checklists were used in 828 of 976 clinical notes, giving a mean adoption rate of 84.8% and utilization rate of 93.9% at six months. Severe pre-eclampsia/eclampsia were associated with the non-use of SCC (2.1% Vs 5.4%, p = 0.017). Stillbirth, neonatal asphyxia, and neonatal death rates were not statistically different between checklist and non-checklist groups. However, in all neonatal outcomes, the proportion of complications was less when the checklist was used.Conclusion: The use of the safe childbirth checklist was associated with significantly reduced pregnancy complications, especially reducing severe pre-eclampsia/ and eclampsia. The use of the safe childbirth checklist increased to 93.9% of all deliveries within six months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.
“…The selection of the BetterBirth intervention as a case study is both a strength and limitation of this paper. During the BetterBirth Trial, the intervention was implemented with good fidelity [18] and the Safe Childbirth Checklist has been used successfully to improve clinical practice and health outcomes in other contexts [22,[77][78][79][80][81][82]. Therefore, the absence of an effect on the primary health outcomes in the BetterBirth Trial suggests that the intervention may not have been sufficiently optimized to address the specific contextual barriers to maternal and neonatal health in Uttar Pradesh [83].…”
Background: Despite extensive efforts to develop and refine intervention packages, complex interventions often fail to produce the desired health impacts in full-scale evaluations. A recent example of this phenomenon is BetterBirth, a complex intervention designed to implement the World Health Organization's Safe Childbirth Checklist and improve maternal and neonatal health. Using data from the BetterBirth Program and its associated trial as a case study, we identified lessons to assist in the development and evaluation of future complex interventions. Methods: BetterBirth was refined across three sequential development phases prior to being tested in a matchedpair, cluster randomized trial in Uttar Pradesh, India. We reviewed published and internal materials from all three development phases to identify barriers hindering the identification of an optimal intervention package and identified corresponding lessons learned. For each lesson, we describe its importance and provide an example motivated by the BetterBirth Program's development to illustrate how it could be applied to future studies. Results: We identified three lessons: (1) develop a robust theory of change (TOC); (2) define optimization outcomes, which are used to assess the effectiveness of the intervention across development phases, and corresponding criteria for success, which determine whether the intervention has been sufficiently optimized to warrant full-scale evaluation; and (3) create and capture variation in the implementation intensity of components. When applying these lessons to the BetterBirth intervention, we demonstrate how a TOC could have promoted more complete data collection. We propose an optimization outcome and related criteria for success and illustrate how they could have resulted in additional development phases prior to the full-scale trial. Finally, we show how variation in components' implementation intensities could have been used to identify effective intervention components. Conclusion: These lessons learned can be applied during both early and advanced stages of complex intervention development and evaluation. By using examples from a real-world study to demonstrate the relevance of these lessons and illustrating how they can be applied in practice, we hope to encourage future researchers to collect and analyze data in a way that promotes more effective complex intervention development and evaluation.
“…As concerns the mechanism by which this occurred, a quasi-experimental study done in Rajasthan, India from 2013 -2015 observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identification, management and timely referral of cases of pre-eclampsia [25]. However, the Better-Birth study, a cluster-randomized, controlled trial in Uttar Pradesh, India, found no significant impact of the SCC intervention on maternal morbidity or mortality [26].…”
Background: Safe childbirth remains a daunting challenge, particularly in low middle income countries, where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 529 per 100,000 live births in 2017 is significantly high. Adherence to essential birth practices by birth attendants is key to improving pregnancy outcomes. The WHO Safe Childbirth Checklist (SCC) was designed as a tool to improve the quality of care provided to women giving birth. It was implemented at the Yaounde Gynaeco-Obsteric and Paediatric Hospital in order to improve quality of care. The purpose of this study was to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, post-partum haemorrhage) and neonatal (foetal death, neonatal asphyxia and neonatal death) complications, six months after introduction at the maternity. Methods: A retrospective study was conducted from January – June 2018. Six months was chosen because research conducted on the SCC in India showed that adherence to essential birth practices was optimal within this period. Data collection sheets were used to document information from delivery records. The Chi square test was used to compare categorical variables, while the student’s T test was used to compare continuous variables. Results: Out of 1611 deliveries conducted, only 1001 records could be traced, giving 38% of missing data. Twenty-five records were excluded. During the study period, checklists were used in 828 clinical notes, giving an adoption rate of 84.8%. Fewer cases of severe pre-ecclampsia/eclampsia were associated with the use of SCC (2·1% Vs 5·4%, p = 0·017). The difference in the proportion of perineal tears, post-partum haemorrhage, stillbirths, neonatal asphyxia and neonatal deaths observed between the checklist and non-checklist groups was not statistically significant. Conclusion: Our results suggest that the SCC program is a cost effective intervention that could potentially reduce maternal mortality and morbidity, most of reduction coming from prevention of severe pre-eclampsia, eclampsia in low-middle income countries.
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