Does the safe childbirth checklist (SCC) program save newborn lives? Evidence from a realistic quasi-experimental study, Rajasthan, India

Abstract

Background The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool focusing on essential care to improve quality of intrapartum care. We aimed to assess the impact of an intervention package using the SCC tool on facility-based stillbirths (SBs) and very early neonatal deaths (vENDs), in Rajasthan, India. Methods Within a quasi-experimental framework, districts were selected as intervention or comparison, matched by annual delivery load. The SCC tool was introduced at all district and sub-district level health facilities in the seven intervention districts, followed by monthly supportive supervision visits. In addition, supply of drugs and equipment were facilitated in all facilities (2013–2015). Facilities in the comparison districts provided routine care. Analysis included only the facilities with a specialized newborn care unit and information on all births was collected from facility registers. The primary outcome was the combined facility-based stillbirths and very early neonatal deaths (within 3-days after birth). We used generalized estimating equation with a Poisson regression model, with time as a linear term and adjusted for facility type in our model to estimate the effect of the intervention. [ ClinicalTrials.gov : NCT01994304]. Results 77,239 births were recorded from 19 intervention facilities and 59,800 births from 15 comparison facilities. The intervention facilities reported 1621 stillbirths and 505 vENDs compared to 1390 stillbirths and 420 vENDs from the comparison facilities (RR 0.89, CI 0.81, 0.97). This translated to 11.16% ( p = 0.01) reduction in total mortality (11.39% in stillbirths alone) in the intervention facilities. Conclusion Our results suggest that the SCC program is an effective intervention that could potentially avert 40,000 intrapartum deaths in India annually, most of reduction coming from prevention of stillbirths.

The growing use of the WHO Safe Childbirth Checklist: Lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon

“…This early blood pressure check ensures early identi cation and management, thus prevents deterioration to severe pre-eclampsia/eclampsia. This view is validated by the quasi-experimental study [26] done in Rajasthan, India, which observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identi cation, management and timely referral of cases of pre-eclampsia [26].…”

“…This view is validated by the quasi-experimental study [26] done in Rajasthan, India, which observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identi cation, management and timely referral of cases of pre-eclampsia [26]. Though, the Better-Birth study, a clusterrandomized, controlled trial in Uttar Pradesh, India, found no signi cant impact of the SCC intervention on maternal morbidity or mortality [27], unavailability of medications and consumables may have been responsible.…”

Optimizing the development and evaluation of complex interventions: lessons learned from the BetterBirth Program and associated trial

“…The selection of the BetterBirth intervention as a case study is both a strength and limitation of this paper. During the BetterBirth Trial, the intervention was implemented with good fidelity [18] and the Safe Childbirth Checklist has been used successfully to improve clinical practice and health outcomes in other contexts [22,[77][78][79][80][81][82]. Therefore, the absence of an effect on the primary health outcomes in the BetterBirth Trial suggests that the intervention may not have been sufficiently optimized to address the specific contextual barriers to maternal and neonatal health in Uttar Pradesh [83].…”

The growing use of the WHO Safe Childbirth Checklist: Lessons learned at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon

“…As concerns the mechanism by which this occurred, a quasi-experimental study done in Rajasthan, India from 2013 -2015 observed a positive behavioural change in health care providers associated with the implementation of the SCC. The greatest difference (64%) was reported in early identification, management and timely referral of cases of pre-eclampsia [25]. However, the Better-Birth study, a cluster-randomized, controlled trial in Uttar Pradesh, India, found no significant impact of the SCC intervention on maternal morbidity or mortality [26].…”