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Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial
  1. Ashish KC1,2,
  2. Anna Bergström1,3,
  3. Dipak Chaulagain1,4,
  4. Olivia Brunell1,
  5. Uwe Ewald1,
  6. Abhishek Gurung4,
  7. Leif Eriksson5,
  8. Helena Litorp1,
  9. Johan Wrammert1,
  10. Erik Grönqvist6,
  11. Per-Anders Edin7,
  12. Claire Le Grange1,
  13. Bikash Lamichhane8,
  14. Parashuram Shrestha8,
  15. Amrit Pokharel8,
  16. Asha Pun2,
  17. Chahana Singh2,
  18. Mats Målqvist1
  1. 1 International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
  2. 2 Health Section, UNICEF, UN House, Lalitpur, Nepal
  3. 3 Institute for Global Health, University College London, London, UK
  4. 4 Lifeline Nepal, Kathmandu, Nepal
  5. 5 Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
  6. 6 Health Economic Forum, Uppsala University, Uppsala, Sweden
  7. 7 Department of Economics, Uppsala University, Uppsala, Sweden
  8. 8 Department of Health Services, Ministry of Health, Nepal
  1. Correspondence to Dr Mats Målqvist; mats.malqvist{at}


Introduction Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.

Methods/design Cluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker’s performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.

Discussion In contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.

Trial registration number ISRCTN30829654.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Handling editor Seye Abimbola

  • Contributors AK and MM conceptualised the study and AB, UE, DC, OB and JW contributed to the development of study design. AG, HL, PE, EG, LE and CL made additions and changes to data collection development. AK and MM drafted the first draft of the manuscript. All authors read and approved of the final version.

  • Funding Einhorn Foundation, Swedish Foundation for International Cooperation in Research and Higher Education (STINT), Swedish Research Council (VR), Laerdal Foundation for Acute Medicine, Norway and UNICEF Nepal country office will support the funding for the study.

  • Competing interests None declared.

  • Ethics approval Ethical review group of Nepal Health Research Council (Ref 2017–1643, 16 March 2017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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