Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India
Background Evidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Prade...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-09-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/9/e002268.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846137868064391168 |
|---|---|
| author | Lisa R Hirschhorn Stuart Lipsitz Atul A Gawande Vishwajeet Kumar Jonathon Gass Ami Karlage Kate A Miller Jennifer Fisher-Bowman Bridget A Neville Margaret Krasne Amanda Jurczak Vinay Pratap Singh Shambhavi Singh Bhalachandra Kodkany |
| author_facet | Lisa R Hirschhorn Stuart Lipsitz Atul A Gawande Vishwajeet Kumar Jonathon Gass Ami Karlage Kate A Miller Jennifer Fisher-Bowman Bridget A Neville Margaret Krasne Amanda Jurczak Vinay Pratap Singh Shambhavi Singh Bhalachandra Kodkany |
| author_sort | Lisa R Hirschhorn |
| collection | DOAJ |
| description | Background Evidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Pradesh, India, we observed a significant increase in adherence to practices, but no reduction in perinatal mortality.Methods Within the BetterBirth trial, we observed birth attendants in a subset of study sites providing care to labouring women to assess the adherence to individual and groups of practices. We observed care from admission to the facility until 1 hour post partum. We followed observed women/newborns for 7-day perinatal health outcomes. Using this observational data, we conducted a post-hoc, exploratory analysis to understand the relationship of birth attendants’ practice adherence to perinatal mortality.Findings Across 30 primary health facilities, we observed 3274 deliveries and obtained 7-day health outcomes. Adherence to individual practices, containing supply preparation and direct provider care, varied widely (0·51 to 99·78%). We recorded 166 perinatal deaths (50·71 per 1000 births), including 56 (17·1 per 1000) stillbirths. Each additional practice performed was significantly associated with reduced odds of perinatal (OR: 0·82, 95% CI: 0·72, 0·93) and early neonatal mortality (OR: 0·78, 95% CI: 0·71, 0·85). Each additional practice as part of direct provider care was associated strongly with reduced odds of perinatal (OR: 0·73, 95% CI: 0·62, 0·86) and early neonatal mortality (OR: 0·67, 95% CI: 0·56, 0·80). No individual practice or single supply preparation was associated with perinatal mortality.Interpretation Adherence to practices on the WHO SCC is associated with reduced mortality, indicating that adherence is a valid indicator of higher quality of care. However, the causal relationships between practices and outcomes are complex.Funding Bill & Melinda Gates Foundation.Trial registration details ClinicalTrials.gov: NCT02148952; Universal Trial Number: U1111-1131-5647. |
| format | Article |
| id | doaj-art-465b6d530f8945999ea241cb6c9bae9b |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-465b6d530f8945999ea241cb6c9bae9b2024-12-07T23:10:13ZengBMJ Publishing GroupBMJ Global Health2059-79082020-09-015910.1136/bmjgh-2019-002268Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, IndiaLisa R Hirschhorn0Stuart Lipsitz1Atul A Gawande2Vishwajeet Kumar3Jonathon Gass4Ami Karlage5Kate A Miller6Jennifer Fisher-Bowman7Bridget A Neville8Margaret Krasne9Amanda Jurczak10Vinay Pratap Singh11Shambhavi Singh12Bhalachandra Kodkany13Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADivision of General Internal Medicine and Primary Care, Brigham and Women`s Hospital, Boston, Massachusetts, USAAriadne Labs at Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USACommunity Empowerment Lab, Lucknow, Uttar Pradesh, IndiaAriadne Labs at Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USAAriadne Labs at Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USAAriadne Labs at Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USAAriadne Labs at Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USAprogrammerDepartment of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USAAriadne Labs at Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USACommunity Empowerment Lab, Lucknow, IndiaCommunity Empowerment Lab, Lucknow, IndiaJawaharlal Nehru Medical College, Belgaum, Karnataka, IndiaBackground Evidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Pradesh, India, we observed a significant increase in adherence to practices, but no reduction in perinatal mortality.Methods Within the BetterBirth trial, we observed birth attendants in a subset of study sites providing care to labouring women to assess the adherence to individual and groups of practices. We observed care from admission to the facility until 1 hour post partum. We followed observed women/newborns for 7-day perinatal health outcomes. Using this observational data, we conducted a post-hoc, exploratory analysis to understand the relationship of birth attendants’ practice adherence to perinatal mortality.Findings Across 30 primary health facilities, we observed 3274 deliveries and obtained 7-day health outcomes. Adherence to individual practices, containing supply preparation and direct provider care, varied widely (0·51 to 99·78%). We recorded 166 perinatal deaths (50·71 per 1000 births), including 56 (17·1 per 1000) stillbirths. Each additional practice performed was significantly associated with reduced odds of perinatal (OR: 0·82, 95% CI: 0·72, 0·93) and early neonatal mortality (OR: 0·78, 95% CI: 0·71, 0·85). Each additional practice as part of direct provider care was associated strongly with reduced odds of perinatal (OR: 0·73, 95% CI: 0·62, 0·86) and early neonatal mortality (OR: 0·67, 95% CI: 0·56, 0·80). No individual practice or single supply preparation was associated with perinatal mortality.Interpretation Adherence to practices on the WHO SCC is associated with reduced mortality, indicating that adherence is a valid indicator of higher quality of care. However, the causal relationships between practices and outcomes are complex.Funding Bill & Melinda Gates Foundation.Trial registration details ClinicalTrials.gov: NCT02148952; Universal Trial Number: U1111-1131-5647.https://gh.bmj.com/content/5/9/e002268.full |
| spellingShingle | Lisa R Hirschhorn Stuart Lipsitz Atul A Gawande Vishwajeet Kumar Jonathon Gass Ami Karlage Kate A Miller Jennifer Fisher-Bowman Bridget A Neville Margaret Krasne Amanda Jurczak Vinay Pratap Singh Shambhavi Singh Bhalachandra Kodkany Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India BMJ Global Health |
| title | Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India |
| title_full | Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India |
| title_fullStr | Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India |
| title_full_unstemmed | Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India |
| title_short | Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India |
| title_sort | does adherence to evidence based practices during childbirth prevent perinatal mortality a post hoc analysis of 3 274 births in uttar pradesh india |
| url | https://gh.bmj.com/content/5/9/e002268.full |
| work_keys_str_mv | AT lisarhirschhorn doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT stuartlipsitz doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT atulagawande doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT vishwajeetkumar doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT jonathongass doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT amikarlage doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT kateamiller doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT jenniferfisherbowman doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT bridgetaneville doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT margaretkrasne doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT amandajurczak doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT vinaypratapsingh doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT shambhavisingh doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia AT bhalachandrakodkany doesadherencetoevidencebasedpracticesduringchildbirthpreventperinatalmortalityaposthocanalysisof3274birthsinuttarpradeshindia |