Abstract
BackgroundIncreasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India.MethodsTwenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009.ResultsSeventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%.ConclusionsThis study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems, protocols and procedures, and for training and research. Simply incentivizing the behaviour of women to use health facilities for childbirth via government schemes may not guarantee safe delivery.
Highlights
Women in India attend health facilities for childbirth, partly due to incentives paid under government programs
India accounts for nearly a fifth of all maternal deaths worldwide, so is an important target country in global efforts to reduce maternal mortality [1,2,3]
A sixteen year study from Northern India found that sepsis was responsible for over 35% of maternal deaths [9] and a study in Southern India revealed that sepsis was a leading cause of maternal death, responsible for 41.9% of deaths [10]
Summary
Women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units cause puerperal sepsis and other infections of childbirth. India accounts for nearly a fifth of all maternal deaths worldwide, so is an important target country in global efforts to reduce maternal mortality [1,2,3]. The current maternal mortality ratio in India is 230 per 100,000 live births [1], with World Health Organization [1], independent studies [2] and national reports [4] broadly concurring. In India, maternal deaths from puerperal sepsis constitute the second most common cause after haemorrhage, accounting for approximately 15% of all maternal deaths [7]. There are few recent studies and little information on infections during childbirth
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