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

Abstract

Background: Safe childbirth remains a daunting challenge, particularly in low middle-income countries, where most pregnancy-related deaths occur. Cameroon's maternal mortality rate, estimated at 529 per 100,000 live births in 2017 is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. It was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods: A retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, post-partum haemorrhage) and neonatal (foetal death, neonatal asphyxia and neonatal death) complications. Data was collected six months after the introduction of the SCC at the maternity. The Chi-square test was used to compare categorical variables, while the student's T-test was used to compare continuous variables. Results: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, checklists were used in 828 of 976 clinical notes, giving a mean adoption rate of 84.8% and utilization rate of 93.9% at six months. Severe pre-eclampsia/eclampsia were associated with the non-use of SCC (2.1% Vs 5.4%, p = 0.017). Stillbirth, neonatal asphyxia, and neonatal death rates were not statistically different between checklist and non-checklist groups. However, in all neonatal outcomes, the proportion of complications was less when the checklist was used.Conclusion: The use of the safe childbirth checklist was associated with significantly reduced pregnancy complications, especially reducing severe pre-eclampsia/ and eclampsia. The use of the safe childbirth checklist increased to 93.9% of all deliveries within six months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.