TY - JOUR
T1 - Improving quality of care during childbirth in primary health centres
T2 - A stepped-wedge cluster-randomised trial in India
AU - QI Haryana Study Collaboration
AU - Agarwal, Ramesh
AU - Chawla, Deepak
AU - Sharma, Minakshi
AU - Nagaranjan, Shyama
AU - Dalpath, Suresh K.
AU - Gupta, Rakesh
AU - Kumar, Saket
AU - Chaudhuri, Saumyadripta
AU - Mohanty, Premananda
AU - Sankar, Mari Jeeva
AU - Agarwal, Krishna
AU - Rani, Shikha
AU - Thukral, Anu
AU - Jain, Suksham
AU - Yadav, Chandra Prakash
AU - Gathwala, Geeta
AU - Kumar, Praveen
AU - Sarin, Jyoti
AU - Sreenivas, Vishnubhatla
AU - Aggarwal, Kailash C.
AU - Kumar, Yogesh
AU - Kharya, Pradip
AU - Bisht, Surender Singh
AU - Shridhar, Gopal
AU - Arora, Raksha
AU - Joshi, Kapil
AU - Bhalla, Kapil
AU - Soni, Aarti
AU - Singh, Sube
AU - Devakirubai, Prischillal
AU - Samuel, Ritu
AU - Yadav, Reena
AU - Bahl, Rajiv
AU - Kumar, Vijay
AU - Paul, Vinod Kumar
AU - Jajoo, Mamta
AU - Kulkarni, Vinay
AU - Gupta, Neeraj
AU - Huria, Anju
AU - Murry, Levis
AU - Agarwal, Prahlad
AU - Kaur, Herbaksh
AU - Duggal, Amit
AU - Khatri, Jaidev
AU - Gupta, Vinod
AU - Passi, Mangat Ram
AU - Mann, V. P.
AU - Malik, Alaknanda
AU - Jain, Bela
AU - Jain, V. K.
N1 - Funding Information:
Funding The study was funded through a grant to the WHO by USAID. The WHO team participated in the protocol development, and provided technical support to the investigators in implementation, analysis of data, interpretation of findings and preparation of the manuscript. The corresponding authors had full access to all the data in the study and bear the final responsibility for deciding about the publication.
Publisher Copyright:
© Author(s) (or their employer(s)) 2018.
PY - 2018/11
Y1 - 2018/11
N2 - 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.
AB - 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.
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U2 - 10.1136/bmjgh-2018-000907
DO - 10.1136/bmjgh-2018-000907
M3 - Article
C2 - 30364301
AN - SCOPUS:85061837461
SN - 2059-7908
VL - 3
JO - BMJ Global Health
JF - BMJ Global Health
IS - 5
M1 - 000907
ER -