Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial
Summary: Background: Although gains in newborn survival have been achieved in many low-income and middle-income countries, reductions in stillbirth and neonatal mortality have been slow. Prematurity complications are a major driver of stillbirth and neonatal mortality. We aimed to assess the effect...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X20302321 |
| _version_ | 1818161700364353536 |
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| author | Dilys Walker, ProfMD Phelgona Otieno, MMED Elizabeth Butrick, MPH Gertrude Namazzi, MBChB Kevin Achola, MSc Rikita Merai, MPH Christopher Otare, BSc Paul Mubiri, MStat Rakesh Ghosh, PhD Nicole Santos, PhD Lara Miller, MSc Nancy L Sloan, DrPH Peter Waiswa, PhD |
| author_facet | Dilys Walker, ProfMD Phelgona Otieno, MMED Elizabeth Butrick, MPH Gertrude Namazzi, MBChB Kevin Achola, MSc Rikita Merai, MPH Christopher Otare, BSc Paul Mubiri, MStat Rakesh Ghosh, PhD Nicole Santos, PhD Lara Miller, MSc Nancy L Sloan, DrPH Peter Waiswa, PhD |
| author_sort | Dilys Walker, ProfMD |
| collection | DOAJ |
| description | Summary: Background: Although gains in newborn survival have been achieved in many low-income and middle-income countries, reductions in stillbirth and neonatal mortality have been slow. Prematurity complications are a major driver of stillbirth and neonatal mortality. We aimed to assess the effect of a quality improvement package for intrapartum and immediate newborn care on stillbirth and preterm neonatal survival in Kenya and Uganda, where evidence-based practices are often underutilised. Methods: This unblinded cluster-randomised controlled trial was done in western Kenya and eastern Uganda at facilities that provide 24-h maternity care with at least 200 births per year. The study assessed outcomes of low-birthweight and preterm babies. Eligible facilities were pair-matched and randomly assigned (1:1) into either the intervention group or the control group. All facilities received maternity register data strengthening and a modified WHO Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. Liveborn or fresh stillborn babies who weighed between 1000 g and 2500 g, or less than 3000 g with a recorded gestational age of less than 37 weeks, were included in the analysis. We abstracted data from maternity registers for maternal and birth outcomes. Follow-up was done by phone or in person to identify the status of the infant at 28 days. The primary outcome was fresh stillbirth and 28-day neonatal mortality. This trial is registered with ClinicalTrials.gov, NCT03112018. Findings: Between Oct 1, 2016, and April 30, 2019, 20 facilities were randomly assigned to either the intervention group (n=10) or the control group (n=10). Among 5343 eligible babies in these facilities, we assessed outcomes of 2938 newborn and fresh stillborn babies (1447 in the intervention and 1491 in the control group). 347 (23%) of 1491 infants in the control group were stillborn or died in the neonatal period compared with 221 (15%) of 1447 infants in the intervention group at 28 days (odds ratio 0·66, 95% CI 0·54–0·81). No harm or adverse effects were found. Interpretation: Fresh stillbirth and neonatal mortality among low-birthweight and preterm babies can be decreased using a package of interventions that reinforces evidence-based practices and invests in health system strengthening. Funding: Bill & Melinda Gates Foundation. |
| first_indexed | 2024-12-11T16:21:56Z |
| format | Article |
| id | doaj.art-98999f54be924f1f845553800bc7c3ef |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-11T16:21:56Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-98999f54be924f1f845553800bc7c3ef2022-12-22T00:58:49ZengElsevierThe Lancet Global Health2214-109X2020-08-0188e1061e1070Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trialDilys Walker, ProfMD0Phelgona Otieno, MMED1Elizabeth Butrick, MPH2Gertrude Namazzi, MBChB3Kevin Achola, MSc4Rikita Merai, MPH5Christopher Otare, BSc6Paul Mubiri, MStat7Rakesh Ghosh, PhD8Nicole Santos, PhD9Lara Miller, MSc10Nancy L Sloan, DrPH11Peter Waiswa, PhD12Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA; Correspondence to: Prof Dilys Walker, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94158, USACenter for Clinical Research, Kenya Medical Research Institute, Nairobi, KenyaInstitute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USAMaternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, UgandaCenter for Clinical Research, Kenya Medical Research Institute, Nairobi, KenyaInstitute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USACenter for Clinical Research, Kenya Medical Research Institute, Nairobi, KenyaMaternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, UgandaInstitute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USAInstitute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USAInstitute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USAInstitute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USAMaternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; Global Health Department of Public Health Sciences, Karolinska Institutet, Stockholm, SwedenSummary: Background: Although gains in newborn survival have been achieved in many low-income and middle-income countries, reductions in stillbirth and neonatal mortality have been slow. Prematurity complications are a major driver of stillbirth and neonatal mortality. We aimed to assess the effect of a quality improvement package for intrapartum and immediate newborn care on stillbirth and preterm neonatal survival in Kenya and Uganda, where evidence-based practices are often underutilised. Methods: This unblinded cluster-randomised controlled trial was done in western Kenya and eastern Uganda at facilities that provide 24-h maternity care with at least 200 births per year. The study assessed outcomes of low-birthweight and preterm babies. Eligible facilities were pair-matched and randomly assigned (1:1) into either the intervention group or the control group. All facilities received maternity register data strengthening and a modified WHO Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. Liveborn or fresh stillborn babies who weighed between 1000 g and 2500 g, or less than 3000 g with a recorded gestational age of less than 37 weeks, were included in the analysis. We abstracted data from maternity registers for maternal and birth outcomes. Follow-up was done by phone or in person to identify the status of the infant at 28 days. The primary outcome was fresh stillbirth and 28-day neonatal mortality. This trial is registered with ClinicalTrials.gov, NCT03112018. Findings: Between Oct 1, 2016, and April 30, 2019, 20 facilities were randomly assigned to either the intervention group (n=10) or the control group (n=10). Among 5343 eligible babies in these facilities, we assessed outcomes of 2938 newborn and fresh stillborn babies (1447 in the intervention and 1491 in the control group). 347 (23%) of 1491 infants in the control group were stillborn or died in the neonatal period compared with 221 (15%) of 1447 infants in the intervention group at 28 days (odds ratio 0·66, 95% CI 0·54–0·81). No harm or adverse effects were found. Interpretation: Fresh stillbirth and neonatal mortality among low-birthweight and preterm babies can be decreased using a package of interventions that reinforces evidence-based practices and invests in health system strengthening. Funding: Bill & Melinda Gates Foundation.http://www.sciencedirect.com/science/article/pii/S2214109X20302321 |
| spellingShingle | Dilys Walker, ProfMD Phelgona Otieno, MMED Elizabeth Butrick, MPH Gertrude Namazzi, MBChB Kevin Achola, MSc Rikita Merai, MPH Christopher Otare, BSc Paul Mubiri, MStat Rakesh Ghosh, PhD Nicole Santos, PhD Lara Miller, MSc Nancy L Sloan, DrPH Peter Waiswa, PhD Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial The Lancet Global Health |
| title | Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial |
| title_full | Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial |
| title_fullStr | Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial |
| title_full_unstemmed | Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial |
| title_short | Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial |
| title_sort | effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low birthweight babies in kenya and uganda a cluster randomised facility based trial |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X20302321 |
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