Abstract
BackgroundContinued progress in reducing maternal and newborn morbidity and mortality in low-income countries requires a renewed focus on quality of delivery care. Reliable electricity and lighting is a cornerstone of a well-equipped health system, but most primary maternity care facilities in sub-Saharan Africa are either not connected to the electrical grid or suffer frequent blackouts. Lack of reliable electricity and light in maternity facilities may contribute to poor quality of both routine and emergency obstetric and newborn care, by hindering infection control, increasing delays in providing care, and reducing health worker morale. The “Solar Suitcase” is a solar electric system designed specifically for maternity care facilities in low-resource environments. The purpose of this trial is to evaluate the impact of the Solar Suitcase on reliability of light, quality of obstetric and newborn care, and health worker satisfaction.MethodsWe are conducting a study with 30 maternity care facilities in rural Uganda that lack access to a reliable, bright light source. The study is a stepped wedge cluster randomized controlled trial. Study facilities are identified according to predefined eligibility criteria, and randomized by blocking on baseline covariates. The intervention is a “Solar Suitcase”, a complete solar electric system that provides essential lighting and power for charging phones and small medical devices. The primary outcomes are the reliability and quality of light during intrapartum care, the process quality of obstetric and newborn care, and health worker satisfaction. Outcomes will be assessed via direct clinical observation by trained enumerators (estimated n = 1980 birth observations), as well as interviews with health workers and facility managers. Lighting and blackouts will be captured through direct observation and via light sensors installed in facilities.DiscussionA key feature of a high quality health system is appropriate infrastructure, including reliable, bright lighting and electricity. Rigorous evidence on the role of a reliable light source in maternal and newborn care is needed to accelerate the “electrification” of maternity facilities across sub-Saharan Africa. This study will be the first to rigorously assess the extent to which reliable light is an important driver of the quality of care experienced by women and newborns.Trial registrationClinicalTrials.gov: NCT03589625 (July 18, 2018); socialscienceregistry.org: AEARCTR-0003078 (dated June 16, 2018).
Highlights
Continued progress in reducing maternal and newborn morbidity and mortality in low-income countries requires a renewed focus on quality of delivery care
Notes. a“Satisfactory” defined as observation that occurs during the day or observation that occurs during night and uses grid electricity, solar power, or functional generator b“Adequate” light defined as light from a satisfactory source and is recorded by enumerator as “very bright” or “somewhat bright” cSatisfaction defined as agree/strongly agree with both statements: "I am satisfied with the availability and brightness of light in this facility" and "I am satisfied with the availability of electricity in this facility" dOverall satisfaction defined as average score of following items: "i) These days, I feel motivated to work as hard as I can. ii) Overall, I am satisfied with my job. iii)
The maternal health community has called for a “quality revolution” [37], urging policymakers and researchers to focus on improving access to safe, effective and respectful delivery care
Summary
Study context Uganda has a population of about 34.6 million people, with 48% below the age of 15, and an estimated 79% living in rural areas [23]. Qualitative observations Enumerators will record qualitative observations of deliveries, including commentary on how light and electricity may have influenced the care provided, as well as contextual information about facility supplies, staffing, operations, and use of the Solar Suitcase components that may provide insight into interpretation of quantitative data. A“Satisfactory” defined as observation that occurs during the day or observation that occurs during night and uses grid electricity, solar power, or functional generator (rather than kerosene lamp, candle, or torch) b“Adequate” light defined as light from a satisfactory source and is recorded by enumerator as “very bright” or “somewhat bright” (rather than “dim” or “pitch black”) cSatisfaction defined as agree/strongly agree with both statements: "I am satisfied with the availability and brightness of light in this facility" and "I am satisfied with the availability of electricity in this facility" dOverall satisfaction defined as average score of following items: "i) These days, I feel motivated to work as hard as I can. Checks woman’s HIV status (checks chart or asks woman) and/or offers woman HIV test
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
