RT Journal Article
SR Electronic
T1 Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e002268
DO 10.1136/bmjgh-2019-002268
VO 5
IS 9
A1 Katherine EA Semrau
A1 Kate A Miller
A1 Stuart Lipsitz
A1 Jennifer Fisher-Bowman
A1 Ami Karlage
A1 Bridget A Neville
A1 Margaret Krasne
A1 Jonathon Gass
A1 Amanda Jurczak
A1 Vinay Pratap Singh
A1 Shambhavi Singh
A1 Megan Marx Delaney
A1 Lisa R Hirschhorn
A1 Bhalachandra Kodkany
A1 Vishwajeet Kumar
A1 Atul A Gawande
YR 2020
UL http://gh.bmj.com/content/5/9/e002268.abstract
AB 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.