A checklist and coaching programme designed by the World Health Organisation (WHO) to improve birth outcomes and target the major causes of death in Uttar Pradesh -- India's most populous state and among those with highest birth-related mortality rates -- has produced unsatisfactory results, finds a study.The "BetterBirth study" has revealed that while community and primary health centres across the northern Indian state achieved marked improvement in the quality of childbirth care delivered for women and newborns using the intervention, the improvements were insufficient to change death rates. In the programme, conducted from 2014 to 2016, birth attendants and managers at 60 rural health centres in the state were coached on use of the WHO's Safe Childbirth Checklist.This included birth attendants consistently following basic practices such as handwashing and use of clean gloves to prevent infection, blood pressure monitoring, provision of uterine massage and appropriate medication to reduce deaths and complications.
However, researchers from Harvard's T.H. Chan School of Public Health, found that the programme had no significant effect on primary composite outcome with respect to maternal and perinatal health, nor on any secondary health outcomes, despite significantly higher rates of birth attendants' adherence to essential practices in intervention facilities.No difference was found in stillbirths, seven-day newborn mortality, and seven-day maternal mortality and morbidity between the intervention and control group. Perinatal mortality, for instance, was 47 deaths per 1,000 live births in both groups, and a maternal morbidity (11.6 per cent) that were much higher than anticipated, revealed the study appearing in the New England Journal of Medicine. The lack of impact on death rates was attributed to the persistent gaps in skills, in supplies, or in systems for care of complications. "In the end, a checklist cannot substitute for other critical components of the health system. The agenda now is to bring together all of these system improvements so we can provide women and infants in UP with the best possible care and outcomes," said co-author Vishwajeet Kumar, Executive Director of the Community Empowerment Lab in Lucknow.On the other hand, the programme encouraged better communication and teamwork among birthing teams, helped clinical teams identify gaps in care, empowered birth attendants to solve problems around supply availability, fostered a more patient-centred culture, and served as a point of pride for facilities that followed the checklist.
"We can build on this progress with initiatives that further strengthen the health system and provide the missing links required for reductions in mortality," Kumar added.The randomised controlled trial involved more than 300,000 mothers and newborns who received care between 2014 and 2016. It compared outcomes in 60 facilities that received an eight-month coaching programme on the checklist with those that did not receive the intervention.