ArticleBMJ global health2018
Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India.
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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8 citing papers in PubMed, 15 citations in OpenAlex.
- A decision-tree model to evaluate the impacts of workforce investments aimed at strengthening emergency obstetric and neonatal care (EmONC) facilities in Burundi.Cost effectiveness and resource allocation : C/E · 2026Article
- Quality of maternal and newborn health services and their impact on maternal-neonatal outcome at a primary health center.Journal of family medicine and primary care · 2024Article
- Improving the Quality of Health Care in Special Neonatal Care Units of India: A Before and After Intervention Study.Global health, science and practice · 2022Article
- Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study.PLoS medicine · 2021Article
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- A qualitative study of the perspectives of health workers and policy makers on external support provided to low-level private health facilities in a Ugandan rural district, in management of childhood infections.Global health action · 2021Article
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Authors and funding
36 authors at 16 institutions in 2 countries.
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Abstract
backgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.
methodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for 'months of intervention'.
resultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.
conclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. TRIAL REGISTRATION NUMBER: CTRI/2016/05/006963.
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