Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India

Autor: Katherine E A, Semrau, Lisa R, Hirschhorn, Megan, Marx Delaney, Vinay P, Singh, Rajiv, Saurastri, Narender, Sharma, Danielle E, Tuller, Rebecca, Firestone, Stuart, Lipsitz, Neelam, Dhingra-Kumar, Bhalachandra S, Kodkany, Vishwajeet, Kumar, Atul A, Gawande, Shambhavi, Singh
Rok vydání: 2017
Předmět:
Quality management
Intervention group
Coaching
law.invention
0302 clinical medicine
Randomized controlled trial
030202 anesthesiology
Pregnancy
law
Outcome Assessment
Health Care
Health care
Childbirth
Medicine
030212 general & internal medicine
030219 obstetrics & reproductive medicine
Obstetrics and Gynecology
Standard of Care
Early Neonatal Mortality
Maternal Morbidity
General Medicine
Birth Attendants
Quality Improvement
Checklist
Intention to Treat Analysis
Maternal Mortality
Randomized Controlled Trial
Female
Maternal death
Guideline Adherence
Uttar pradesh
Research Article
Adult
Uttar Pradesh
medicine.medical_specialty
India
WHO Safe Childbirth Checklist
Midwifery
World Health Organization
World health
03 medical and health sciences
Humans
Essential Birth Practices
Behavior Change
Perinatal Mortality
Chi-Square Distribution
business.industry
Parturition
Infant
Newborn
Mentoring
Puerperal Disorders
Delivery
Obstetric
medicine.disease
Public Health Facility
Family medicine
business
Zdroj: The New England Journal of Medicine
ISSN: 1533-4406
0028-4793
DOI: 10.1056/nejmoa1701075
Popis: The prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes.We conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery. Outcomes - assessed 8 to 42 days after delivery - were compared between the intervention group and the control group with adjustment for clustering and matching. We also compared birth attendants' adherence to 18 essential birth practices in 15 matched pairs of facilities at 2 and 12 months after the initiation of the intervention.Of 161,107 eligible women, we enrolled 157,689 (97.9%) and determined 7-day outcomes for 157,145 (99.7%) mother-newborn dyads. Among 4888 observed births, birth attendants' mean practice adherence was significantly higher in the intervention group than in the control group (72.8% vs. 41.7% at 2 months; 61.7% vs. 43.9% at 12 months; P0.001 for both comparisons). However, there was no significant difference between the trial groups either in the composite primary outcome (15.1% in the intervention group and 15.3% in the control group; relative risk, 0.99; 95% confidence interval, 0.83 to 1.18; P=0.90) or in secondary maternal or perinatal adverse outcomes.Birth attendants' adherence to essential birth practices was higher in facilities that used the coaching-based WHO Safe Childbirth Checklist program than in those that did not, but maternal and perinatal mortality and maternal morbidity did not differ significantly between the two groups. (Funded by the Bill and Melinda Gates Foundation; Clinical Trials number, NCT02148952 .).
Databáze: OpenAIRE
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