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

BMC Pregnancy and Childbirth

Research Article

Md Tariqujjaman¹  Herfina Y. Nababan²  Rubana Islam³  Corrina Moucheraud⁴  Shabnam Mostari⁵  Malabika Sarker⁵  Mohammad Tajul Islam⁶ 

[1] Centre for Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, 1212, Dhaka, Bangladesh;Centre for Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, 1212, Dhaka, Bangladesh;Nossal Institute for Global Health, Melbourne School of Population and Global Health, the University of Melbourne, 333 Exhibition Street, 3004, Melbourne, Victoria, Australia;Centre for Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, 1212, Dhaka, Bangladesh;School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia;Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, 90095, Los Angeles, CA, USA;James P. Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, 1212, Dhaka, Bangladesh;Japan International Cooperation Agency (JICA), 3rd Floor, Bay’s Galleria, 57 Gulshan Avenue (CWS-A19), Gulshan-1, 1212, Dhaka, Bangladesh;

关键词: Maternal and newborn health;    Safe Childbirth Checklist;    Quality of care;    Health worker performance;    Health service delivery;    Bangladesh;   

DOI  :  10.1186/s12884-017-1588-x

 received in 2017-03-02, accepted in 2017-11-22,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017