Abstract
BackgroundA strong evidence base exists regarding routine and emergency services that can effectively prevent or reduce maternal and new-born mortality. However, even when skilled providers care for women in labour, many of the recommended services are not provided, despite being available. Barriers to the provision of appropriate childbirth services may include lack of availability of supplies, limited health worker knowledge and confidence, or inadequate time. The WHO Safe Childbirth Checklist (SCC) includes reminders for evidenced-based practices at specific points in the childbirth process. Zambia is currently considering nation-wide adoption of the SCC, but there is a need for context-specific evidence. Beginning in September 2017, a program is being implemented in Nchelenge District to pilot use of the SCC, along with coaching that focuses on strengthening the systems that allow the essential practices in childbirth to be performed.MethodsThis study will use a pre-post study design to measure health worker adherence to the essential practices for delivery care outlined in the SCC. Data will be collected through observations of health workers as they care for mothers during childbirth at four facilities. Data collection will take place before the start of the intervention, at 3 months, and at 6 months post-intervention. The primary outcome interest is the change in the average proportion of essential childbirth practices completed. A health worker questionnaire will be administered at the time that the SCC is introduced and 6 months later to gather their perspectives on incorporating the SCC into clinical practice in Zambia.DiscussionFindings are expected to inform plans for introducing the SCC in Zambia. This evaluation will aim to understand uptake and impact of the SCC and associated coaching in the context of a basic level of mentorship that the government could feasibly provide at a national scale.Trial registrationClinical Trials.gov (NCT03263182) Registered August 28, 2017.
Highlights
A strong evidence base exists regarding routine and emergency services that can effectively prevent or reduce maternal and new-born mortality
Maternal and new-born mortality can be prevented through the provision of basic health services for all women and appropriate emergency obstetric and new-born care (EmONC) services for women and infants who need it [3]
We have developed a list of selected tasks that represent a sub-set of items in the Safe Childbirth Checklist (SCC) which are tasks that can be visually observed and that are non-conditional
Summary
A strong evidence base exists regarding routine and emergency services that can effectively prevent or reduce maternal and new-born mortality. Barriers to the provision of appropriate childbirth services may include lack of availability of supplies, limited health worker knowledge and confidence, or inadequate time. A further challenge is that even when mothers go to health facilities, the appropriate staffing and supplies may not always be available to support the provision of essential childbirth services. The facility must be staffed by a skilled birth attendant (SBA), which is an accredited health professional such as a midwife, clinical officer, doctor, or other health worker who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in identification, management and referral of complications in women and new-borns [4]. Possible factors associated with poor quality services could be limited health worker knowledge, confidence, and time
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