256: Impact of WHO Safe Childbirth Checklist on knowledge and practice of OB providers in Rwanda

Abstract

To evaluate if implementation of the WHO Safe Childbirth Checklist (SCC) can improve delivery of essential childbirth practices in Rwanda. Prospective study utilizing a pre-post intervention design was conducted in labor, post- partum and recovery wards at Kigali University Teaching Hospital (CHUK), Rwanda. Surveys were conducted using frontline healthcare workers (midwives, nurses and residents) responsible for intra- and post-partum care. Birth events occurring at CHUK in the six months preceding the pilot and during the six-month pilot period were reviewed. Eligible charts included singleton pregnancies from time of admission to labor and delivery until twenty- four hours post-partum. A sample size of 326 birth events was calculated, 163 events pre- and post-checklist implementation. Patients admitted with an intrauterine fetal demise were excluded. Fifty-three participants were enrolled (62% midwives/nurses, and 38% residents). After implementation, 50 respondents re-answered the survey. During the six-month pilot period, knowledge and practice of obstetrical health care providers increased from 50% to 80% and from 57% to 90%, respectively. Knowledge of management of hypertensive disorders increased from 51% to 83% (p=0.001), diagnosing labor dystocia increased from 60% to 89% (p=0.001) and correct indication of antibiotic administration during labor and delivery increased from 47% to 77% (p=0.002). The quality of obstetrical health care was found to be improved proportional to the knowledge and practice, mainly in labor monitoring and chart documentation. Documentation of almost all tasks reviewed improved to 90% during the post-pilot period. Labor dystocia was decreased from 21% to 12% (p<0.001). Oxytocin administration within one minute post-partum increased from 44% to 74% (p<0.001). There was no impact on the diagnosis of postpartum hemorrhage or hypertensive disease. In a six-month period following pilot implementation of WHO SCC, there was positive improvement of knowledge and practice of obstetrical providers. There was also an overall increase in reinstitution of recommended practices in obstetrical care that address the major causes of intra-partum stillbirths and maternal and neonatal complications.