Trial reportBMJ global health2020
Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India.
Trial report in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02148952 (A Matched-pair, Cluster Randomized Trial to Measure the Efficacy of the WHO Safe Childbirth Checklist Program on Severe Maternal, Fetal and Newborn Harm), which is not on this map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Matched-pair, Cluster Randomized Trial to Measure the Efficacy of the WHO Safe Childbirth Checklist Program on Severe Maternal, Fetal and Newborn Harm
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Burden, Differentials and Causes of Stillbirths in India: A Systematic Review and Meta Analysis.Indian journal of pediatrics · 2023Pooled it
- A Perioperative Quality Improvement Program for Cesarean Delivery in Ethiopia: A Stepped-Wedge Cluster Randomized Clinical Trial.JAMA network open · 2024Trial
- Adherence to evidence-based intrapartum care practices and influencing factors among obstetric care providers in Ethiopia: A systematic review and meta-analysis.European journal of obstetrics & gynecology and reproductive biology: X · 2025Review
- The Impact of Prenatal Care on the Prevention of Neonatal Outcomes: A Systematic Review and Meta-Analysis of Global Health Interventions.Healthcare (Basel, Switzerland) · 2025Review
- Observation of non-recommended (harmful) intrapartum practices among obstetric care providers in public hospitals in southern Ethiopia, 2023.PLOS global public health · 2024Article
- Barriers and facilitators for implementing the WHO Safe Childbirth Checklist (SCC) in Mozambique: A qualitative study using the Consolidated Framework for Implementation Research (CFIR).PLOS global public health · 2024Article
- Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India's Private Sector.Global health, science and practice · 2022Article
- Examining the variations in the implementation of interventions to address stillbirth from the national to subnational levels: experiences from Uganda.Health research policy and systems · 2022Article
- Article
- The WHO safe childbirth checklist after 5 years: future directions for improving outcomes.The Lancet. Global health · 2022Review
- Adaptation and implementation of the WHO Safe Childbirth Checklist around the world.Implementation science communications · 2021Article
- Implementation of Evidence-Based Intrapartum Care and its Associated Factors Among Obstetric Care Providers Working in South Ethiopia.SAGE open nursingArticle
Corrections and comments
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEvidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Pradesh, India, we observed a significant increase in adherence to practices, but no reduction in perinatal mortality.
methodsWithin the BetterBirth trial, we observed birth attendants in a subset of study sites providing care to labouring women to assess the adherence to individual and groups of practices. We observed care from admission to the facility until 1 hour post partum. We followed observed women/newborns for 7-day perinatal health outcomes. Using this observational data, we conducted a post-hoc, exploratory analysis to understand the relationship of birth attendants' practice adherence to perinatal mortality.
findingsAcross 30 primary health facilities, we observed 3274 deliveries and obtained 7-day health outcomes. Adherence to individual practices, containing supply preparation and direct provider care, varied widely (0·51 to 99·78%). We recorded 166 perinatal deaths (50·71 per 1000 births), including 56 (17·1 per 1000) stillbirths. Each additional practice performed was significantly associated with reduced odds of perinatal (OR: 0·82, 95% CI: 0·72, 0·93) and early neonatal mortality (OR: 0·78, 95% CI: 0·71, 0·85). Each additional practice as part of direct provider care was associated strongly with reduced odds of perinatal (OR: 0·73, 95% CI: 0·62, 0·86) and early neonatal mortality (OR: 0·67, 95% CI: 0·56, 0·80). No individual practice or single supply preparation was associated with perinatal mortality.
interpretationAdherence to practices on the WHO SCC is associated with reduced mortality, indicating that adherence is a valid indicator of higher quality of care. However, the causal relationships between practices and outcomes are complex.
fundingBill & Melinda Gates Foundation. TRIAL REGISTRATION DETAILS: ClinicalTrials.gov: NCT02148952; Universal Trial Number: U1111-1131-5647.
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