Impact of the Safe Childbirth Checklist on health worker childbirth practices in Luapula province of Zambia: a pre-post study

Abstract

Background: A strong evidence base exists regarding routine and emergency services that can effectively prevent or reduce maternal and new-born mortality. However, even when skilled providers care for women in labour, many of the recommended services are not provided, despite being available. Barriers to the provision of appropriate childbirth services may include lack of availability of supplies, limited health worker knowledge and confidence, or inadequate time. The WHO Safe Childbirth Checklist (SCC) includes reminders for evidenced-based practices at specific points in the childbirth process. Zambia is currently considering nation-wide adoption of the SCC, but there is a need for context-specific evidence. Beginning in September 2017, a program is being implemented in Nchelenge District to pilot use of the SCC, along with coaching that focuses on strengthening the systems that allow the essential practices in childbirth to be performed.

Methods: This study will use a pre-post study design to measure health worker adherence to the essential practices for delivery care outlined in the SCC. Data will be collected through observations of health workers as they care for mothers during childbirth at four facilities. Data collection will take place before the start of the intervention, at 3 months, and at 6 months post-intervention. The primary outcome interest is the change in the average proportion of essential childbirth practices completed. A health worker questionnaire will be administered at the time that the SCC is introduced and 6 months later to gather their perspectives on incorporating the SCC into clinical practice in Zambia.

Discussion: Findings are expected to inform plans for introducing the SCC in Zambia. This evaluation will aim to understand uptake and impact of the SCC and associated coaching in the context of a basic level of mentorship that the government could feasibly provide at a national scale.

Trial registration: Clinical Trials.gov ( NCT03263182 ) Registered August 28, 2017.

Keywords: Maternal health; Newborn health; WHO Safe Childbirth Checklist.

Conflict of interest statement

Ethics approval and consent to participate

Approval to undertake the study has been granted by two research ethics committees: Chesapeake IRB where approval was granted on 15 June 2017 (Pro00022097) and ERES Converge IRB where approval was granted on 8 July 2017 (2017-May-066). The study also has approval from the National Health Research Authority in Zambia.

Health worker consent for delivery observations:

At the beginning of the data collection process the evaluation and observers will be introduced to all skilled birth personnel in the facility and they will be asked to provide written informed consent for their services to be observed. Data collectors will not interfere with clinical care during their observations. For ethical reasons, they will be instructed to notify HCWs if they observe a potentially harmful condition or practice.

Patient consent for delivery observations:

At the time when a pregnant woman presents at the health facility in labor, the HCW that will be managing the delivery process will be asked to inform the woman that a review of the childbirth services in that facility is going on and that a data collector will be approaching her to ask about observing the services provided during her delivery. The observers will be asked to obtain written informed consent from each woman for their delivery to be observed. For the sake of anonymity of the mother and considering the circumstances under which the potential participant will be under, the HCW performing the delivery services will be asked to act as the witness on the consent form, if the woman agrees to participate.

Health worker questionnaires at SCC training and end line:

When questionnaires are passed around, study staff will explain that participation is voluntary, responses are anonymous, and the decision on whether to participate will have no impact on the health workers’ relationship with the MOH.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.