Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India
Year: 2018
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: Low/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models. METHODS: We conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for 'months of intervention'. RESULTS: The intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities. CONCLUSION: A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. TRIAL REGISTRATION NUMBER: CTRI/2016/05/006963.
Source: BMJ Global Health
Authors: Ramesh Agarwal, Deepak Chawla, Minakshi Sharma, Shyama Nagaranjan, Suresh K Dalpath, Rakesh Gupta, Saket Kumar, Saumyadripta Chaudhuri, Premananda Mohanty, Mari Jeeva Sankar, Krishna Agarwal, Shikha Rani, Anu Thukral, Suksham Jain, Chandra Prakash Yadav, Geeta Gathwala, Praveen Kumar, Jyoti Sarin, Vishnubhatla Sreenivas, Kailash C Aggarwal, Yogesh Kumar, Pradip Kharya, Surender Singh Bisht, Gopal Shridhar, Raksha Arora, Kapil Joshi, Kapil Bhalla, Aarti Soni, Sube Singh, Prischillal Devakirubai, Ritu Samuel, Reena Yadav, Rajiv Bahl, Vijay Kumar, Vinod Kumar Paul
Institutions: All India Institute of Medical Sciences, Government Medical College and Hospital, Foundation for Survival of Women and Children, Maulana Azad Medical College, National Institute of Malaria Research, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Post Graduate Institute of Medical Education and Research, Safdarjang Hospital, Vardhman Mahavir Medical College & Safdarjung Hospital, Santosh University, United Nations Children's Fund India, Lady Hardinge Medical College, World Health Organization
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,679
OpenAlex ID: W2896712945