Improving quality of care for maternal and newborn health: a pre-post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh

Herfina Y Nababan,Shabnam Mostari,Malabika Sarker,Rubana Islam,Md Tariqujjaman,Mohammad Tajul Islam,Corrina Moucheraud

doi:10.1186/s12884-017-1588-x

Abstract

BackgroundBangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists. High-quality maternal health care is necessary to address this burden. Implementation of WHO Safe Childbirth Checklist (SCC), whose items address the major causes of maternal deaths, is hypothesized to improve adherence of providers to essential childbirth practices.MethodThe SCC was adapted for the local context through expert consultation meetings, creating a total of 27 checklist items. This study was a pre-post evaluation of SCC implementation. Data were collected over 8 months at Magura District Hospital. We analysed 468 direct observations of birth (main analysis using 310 complete observations and sensitivity analysis with the additional 158 incomplete observations) from admission to discharge. The primary outcome of interest was the number of essential childbirth practices performed before compared to after SCC implementation. The change was assessed using adjusted Poisson regression models accounting for clustering by nurse-midwives.ResultAfter checklist introduction, significant improvements were observed: on average, around 70% more of these safe childbirth practices were performed in the follow-up period compared to baseline (from 11 to 19 out of 27 practices). Substantial increases were seen in communication between nurse-midwives and mothers (counselling), and in management of complications (including rational use of medicines). In multivariable models that included characteristics of the mothers and of the nurse-midwives, the rate of delivering the essential childbirth practices was 1.71 times greater in the follow-up compared to baseline (95% CI 1.61–1.81).ConclusionImplementation of SCC has the potential to improve essential childbirth practice in resource-poor settings like Bangladesh. This study emphasizes the need for health system strengthening in order to achieve the full advantages of SCC implementation.

Highlights

Bangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists
While the current neonatal mortality rate of 28 per 1000 live births has been lower than the target of 48 deaths per 1000 live births, its maternal mortality ratio (MMR) decreased from 574 maternal deaths per 100,000 live births in 1991 to 176 deaths per 100,000 live births in 2015 [7, 8]; and use of facility delivery increased over this period [9]
Adaptation of the Safe Childbirth Checklist (SCC) There was a series of consultative meetings between study investigators and external experts (obstetricians and neonatologists from Bangabandhu Sheikh Mujib Medical University, Shaheed Suhrawardy Medical College Hospital; and public health scientists and researchers affiliated with BRAC, the International Center for Diarrhoeal Disease Research, Bangladesh, Japan International Cooperation Agency (JICA), and James P

Summary

Introduction

Bangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists. The world achieved major gains in maternal and child survival and in coverage of facility-based childbirth and skilled birth attendance [2, 3]. Continue to die during and shortly after childbirth, and disparities persist across countries as well as across groups within countries [1, 2] This suggests that the global strategy, which has focused on increasing coverage of skilled birth attendance, did not eliminate all excess burden [4]. Still only 37% of births occur at health facilities, with much lower rates among poorer women, and provision of quality care during childbirth remains a particular challenge [9,10,11]

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