Effectiveness of the WHO SCC on improving adherence to essential practices during childbirth, in resource constrained settings

Somesh Kumar, Vikas Yadav, Sudharsanam Balasubramaniam, Yashpal Jain, Chandra Shekhar Joshi, Kailash Saran, Bulbul Sood, Somesh Kumar, Vikas Yadav, Sudharsanam Balasubramaniam, Yashpal Jain, Chandra Shekhar Joshi, Kailash Saran, Bulbul Sood

Abstract

Background: India accounts for 27 % of world's neonatal deaths. Although more Indian women deliver in facilities currently than a decade ago, early neonatal mortality has not declined, likely because of insufficient quality of care. The WHO Safe Childbirth Checklist (SCC) was developed to support health workers to perform essential practices known to reduce preventable maternal and new-born deaths around the time of childbirth. Despite promising early research many outstanding questions remain about effectiveness of the SCC in low-resource settings.

Methods: In collaboration with the Ministry of Health SCC was modified for Indian context and introduced in 101 intervention facilities in Rajasthan, India and 99 facilities served as comparison to study if it reduces mortality. This Quasi experimental Observational intervention-comparison was embedded in this larger program to test whether a program for introduction of SCC with simple implementation package was associated with increased adherence to 28 evidence-based practices. This study was conducted in 8 intervention and 8 comparison sites. Program interventions to promote appropriate use of the SCC included orienting providers to the checklist, modest modifications of the SCC to promote provider uptake and accountability, ensuring availability of essential supplies, and providing supportive supervision for helping providers in using the SCC.

Results: The SCC was used by providers in 86 % of 240 deliveries observed in the eight intervention facilities. Providers in the intervention group significantly adhered to practices included in the SCC than providers in the comparison group controlling for baseline scores and confounders. Women delivering in the intervention facilities received on an average 11.5 more of the 28 practices included compared with women in the comparison facilities. For selected practices provider performance in the intervention group increased as much as 93 % than comparison sites.

Conclusion: Use of the SCC and provider performance of best practices increased in intervention facilities reflecting improvement in quality of facility childbirth care for women and new-born in low resource settings.

Keywords: Intervention; Low resource settings; Practices; Safe Childbirth Checklist.

Figures

Fig. 1
Fig. 1
Average number of Practices done by providers at all pause point in observational study

References

    1. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375(9726):1609–23. doi: 10.1016/S0140-6736(10)60518-1.
    1. Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJ. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011;378(9797):1139–65. doi: 10.1016/S0140-6736(11)61337-8.
    1. Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, Dwyer L, Costa M, Lopez AD, Murray CJ. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet. 2010;375(9730):1988–2008. doi: 10.1016/S0140-6736(10)60703-9.
    1. United Nations . The Millennium Development Goals Report - Addendum. 2014.
    1. Campbell OM, Graham WJ. Lancet Maternal Survival Series steering group: Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99. doi: 10.1016/S0140-6736(06)69381-1.
    1. Mason E, McDougall L, Lawn JE, Gupta A, Claeson M, Pillay Y, Presern C, Lukong MB, Mann G, Wijnroks M, Azad K, Taylor K, Beattie A, Bhutta ZA, Chopra M. Lancet Every Newborn Study Group, Every Newborn Steering Committee: From evidence to action to deliver a healthy start for the next generation. Lancet. 2014;384(9941):455–67. doi: 10.1016/S0140-6736(14)60750-9.
    1. Levels & Trends in Child Mortality . Report 2013 eEstimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York: Levels & Trends in Child Mortality; 2013.
    1. Registrar General of India . Sample Registration System (SRS) statistical report 2011. 2012.
    1. National institute of public cooperation and child development . Statistics on Children In India. 2013.
    1. Barnes-Josiah D, Myntti C, Augustin A. The “three delays” as a framework for examining maternal mortality in Haiti. Soc Sci Med. 1998;46(8):981–93. doi: 10.1016/S0277-9536(97)10018-1.
    1. Barkat A, Rahman M, Bose ML, Com M, Akhter S. Modelling the first two delays of the “three-delays model” for emergency obstetric care in Bangladesh: a choice model approach. J Health Popul Dev Ctries. 1997;1(1):57–67.
    1. Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW. Using the three delays model to understand why newborn babies die in eastern Uganda. Trop Med Int Health. 2010;15(8):964–72. doi: 10.1111/j.1365-3156.2010.02557.x.
    1. Registrar General of India . Sample Registration System (SRS) statistical report 2013. 2013.
    1. Ng M, Misra A, Diwan V, Agnani M, Levin-Rector A, De Costa A. An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India. Glob Health Action. 2014;7:24939.
    1. Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet. 2010;375(9730):2009–23. doi: 10.1016/S0140-6736(10)60744-1.
    1. Ministry of Health and Family Welfare . Government of India: India New Born Action Plan. 2014.
    1. Guidelines. Government of India. . Accessed 5 Feb 2016.
    1. Nagpal J, Sachdeva A, Sengupta Dhar R, Bhargava VL, Bhartia A. Widespread non-adherence to evidence-based maternity care guidelines: a population-based cluster randomised household survey. BJOG. 2015;122(2):238–47. doi: 10.1111/1471-0528.13054.
    1. Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, Blakemore A, Bull AM, Car J, Conteh L, Cooke GS, Ford N, Gregson SA, Kerr K, King D, Kulendran M, Malkin RA, Majeed A, Matlin S, Merrifield R, Penfold HA, Reid SD, Smith PC, Stevens MM, Templeton MR, Vincent C, Wilson E. Technologies for global health. Lancet. 2012;380(9840):507–35. doi: 10.1016/S0140-6736(12)61127-1.
    1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA. Safe Surgery Saves Lives Study Group: A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9. doi: 10.1056/NEJMsa0810119.
    1. Spector JM, Lashoher A, Agrawal P, Lemer C, Dziekan G, Bahl R, Mathai M, Merialdi M, Berry W, Gawande AA. Designing the WHO Safe Childbirth Checklist program to improve quality of care at childbirth. Int J Gynaecol Obstet. 2013;122(2):164–8. doi: 10.1016/j.ijgo.2013.03.022.
    1. Spector JM, Agrawal P, Kodkany B, Lipsitz S, Lashoher A, Dziekan G, Bahl R, Merialdi M, Mathai M, Lemer C, Gawande A. Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program. PLoS One. 2012;7(5):e35151. doi: 10.1371/journal.pone.0035151.
    1. WHO. The Safe Childbirth Checklist Collaboration. . Accessed 5 Feb 2016.
    1. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE. Lancet Nutrition Interventions Review Group, Maternal and Child Nutrition Study Group: Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77. doi: 10.1016/S0140-6736(13)60996-4.
    1. Patel A, Badhoniya N, Khadse S, Senarath U, Agho KE, Dibley MJ. South Asia Infant Feeding Research Netwoork: Infant and young child feeding indicators and determinants of poor feeding practices in India: secondary data analysis of National Family Health Survey 2005–06. Food Nutr Bull. 2010;31(2):314–33. doi: 10.1177/156482651003100221.
    1. National Family Health Survey (NFHS 3) India. 2005–06 . Accessed 5 Feb 2016.
    1. Pati S, Chauhan AS, Panda M, Swain S, Hussain MA. Neonatal care practices in a tribal community of Odisha, India: a cultural perspective. J Trop Pediatr. 2014;60(3):238–44. doi: 10.1093/tropej/fmu005.
    1. Joseph N, Unnikrishnan B, Naik VA, Mahantshetti NS, Mallapur MD, Kotian SM, Nelliyanil M. Infant rearing practices in South India: a longitudinal study. J Family Med Prim Care. 2013;2(1):37–43. doi: 10.4103/2249-4863.109942.
    1. World Bank . Making Services Work for Poor People. World Development Report. 2004.
    1. Blankenberg F. Taking responsibility and demanding rights: Accountability in servicedelivery. The Hague: Ministry of Foreign Affairs; 2007.
    1. Katherine K, Paul Shaw R. Reproductive Health and Health Sector Reform Linking Outcomes to Action. World Bank Institute. 2000.
    1. Patabendige M, Senanayake H. Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience. BMC Pregnancy Childbirth. 2015;15:12–015–0436–0. doi: 10.1186/s12884-015-0436-0.

Source: PubMed

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