Does the safe childbirth checklist (SCC) program save newborn lives? Evidence from a realistic quasi-experimental study, Rajasthan, India

Beena Varghese,Vikas Yadav,Somen Saha,Souvik Bandyopadhyay,Somesh Kumar,Jigyasa Sharma,Andrew Copas,Shwetanjali Kumari

doi:10.1186/s40748-019-0098-4

Abstract

BackgroundThe 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.MethodsWithin a quasi-experimental framework, districts were selected as intervention or comparison, matched by annual delivery load. The SCC tool was introduced at all district and sub-district level health facilities in the seven intervention districts, followed by monthly supportive supervision visits. In addition, supply of drugs and equipment were facilitated in all facilities (2013–2015). Facilities in the comparison districts provided routine care. Analysis included only the facilities with a specialized newborn care unit and information on all births was collected from facility registers. The primary outcome was the combined facility-based stillbirths and very early neonatal deaths (within 3-days after birth). We used generalized estimating equation with a Poisson regression model, with time as a linear term and adjusted for facility type in our model to estimate the effect of the intervention. [ClinicalTrials.gov: NCT01994304].Results77,239 births were recorded from 19 intervention facilities and 59,800 births from 15 comparison facilities. The intervention facilities reported 1621 stillbirths and 505 vENDs compared to 1390 stillbirths and 420 vENDs from the comparison facilities (RR 0.89, CI 0.81, 0.97). This translated to 11.16% (p = 0.01) reduction in total mortality (11.39% in stillbirths alone) in the intervention facilities.ConclusionOur results suggest that the SCC program is an effective intervention that could potentially avert 40,000 intrapartum deaths in India annually, most of reduction coming from prevention of stillbirths.

Highlights

An estimated 2.7 million neonatal deaths and an additional 2.6 million stillbirths occur annually [1,2,3]
We report findings on the effectiveness of the Safe Childbirth Checklist (SCC) program in reducing facility-based stillbirths (SBs) and very early neonatal deaths
Our evaluation study found that the SCC-based intervention in Rajasthan is associated with a statistically significant reduction of 11∙16% (p-value = 0∙01) in stillbirths and very early neonatal deaths, 77% of which was contributed by stillbirths alone

Summary

Introduction

An estimated 2.7 million neonatal deaths and an additional 2.6 million stillbirths occur annually [1,2,3]. As a measure to reduce preventable mortality and morbidity, India successfully increased the proportion of facility-based births, primarily through its conditional cash transfer program, early evaluations indicate that these efforts have a modest impact on reducing mortality [8, 9]. This has been primarily attributed to inadequate attention to quality of both routine and emergency obstetric and newborn care [10, 11]. 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

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