Abstract
BackgroundIndia 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.MethodsIn 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.ResultsThe 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.ConclusionUse 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.
Highlights
India accounts for 27 % of world’s neonatal deaths
The Safe Childbirth Checklist (SCC) was used in 86 % of the observed deliveries in intervention facilities, which implies successful adoption by a majority of providers in the intervention facilities
The composite index of supplies and equipments increased in intervention and comparison sites to 0.9 at end line. 63 % (12/19) of the total doctors trained on SCC at baseline and 92 % (58/63) 92 % of the nurses trained on SCC at baseline were available in intervention facilities at the end line
Summary
India accounts for 27 % of world’s neonatal deaths. more Indian women deliver in facilities currently than a decade ago, early neonatal mortality has not declined, likely because of insufficient quality of care. Achieving the desired reduction in preventable maternal and child mortality remains the unfinished agenda of the Millennium Development Goals (MDGs) [1,2,3,4] This has remained unachieved despite knowing what works for reducing maternal and child mortality in developing country contexts for many years [5, 6] It has been estimated that globally, better care during labor and birth, and care of new-borns immediately after birth can avert up to 1.49 million maternal and new-born deaths and still births.(6) There is an urgent need to fill the gap between evidence and its translation to practices during care provision, in developing country settings. Considering the fact that neonatal deaths account for up to 40 % of under-5 deaths [3], the need for focusing on perinatal care in India is an urgent local and global priority
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