Checklist improves Childbirth Care in South India

May 29, 2012

A new study from the Harvard School of Public Health (HSPH) and the World Health Organization (WHO) has found that a simple checklist dramatically improved adherence to essential childbirth care practices at a pilot hospital in South India.

Of the 29 practices measured in the PLoS ONE study, 28 were improved after adoption of the checklist and overall adherence to essential practices was 150% better after the checklist was introduced.

“This is a significant step forward because it provides hope that use of this simple, low-cost tool can help birth attendants better adhere to universally accepted standards in childbirth care,” said senior author Atul Gawande, professor in health policy and management at HSPH.

Nearly 300,000 maternal deaths, 3.1 million newborn deaths, and 1.2 million intrapartum-related stillbirths take place in low-income countries each year; the vast majority are preventable.

From 2008 to 2010, HSPH and WHO developed the WHO Safe Childbirth Checklist program to address the major causes of maternal and neonatal mortality. As part of its development, the checklist was field tested for usability in 10 countries, mostly in Africa and south Asia.

In the pilot study at a hospital in Karnataka, India, local staff reviewed deficiencies in their current practices and undertook training on using the WHO Safe Childbirth Checklist.

Items on the 29-item checklist address the major causes of maternal deaths (e.g. hemorrhage, infection, obstructed labor, and hypertensive disease), intrapartum-related stillbirths, and neonatal deaths (e.g. complications of premature birth, infection, and birth asphyxia).

Researchers observed the childbirth practices of health care workers during 499 birth events – the period from admission to discharge – prior to introducing the checklist to establish a baseline, and then compared the results with 795 birth events after implementing the checklist.

The results reveal that the number of essential practices performed by the hospital workers increased from an average of 10 of 29 at baseline to 25 of 29 after implementing the checklist.

“The checklist program actively prompted health care workers to remember to complete proven practices such as handwashing, infection management, postpartum bleeding assessment, and breastfeeding within an hour after birth,” said co-author Dr. Bhala Kodkany, professor of obstetrics and gynecology and director of JNMC Women’s and Children’s Health Research Unit in Karnataka, India.

As the study is too small to measure the impact on complications or reducing death, the researchers are now conducting a large-scale trial in more than 100 hospitals in North India to determine if the checklist program can save the lives of women and newborns.

Category: Wellness and Complementary Therapies

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