Varghese Beena, Copas Andrew, Kumari Shwetanjali, Bandyopadhyay Souvik, Sharma Jigyasa, Saha Somen, Yadav Vikas, Kumar Somesh
1Public Health Foundation of India, Plot No 47, Sector 44, Gurugram, Haryana 122002 India.
2University College, London, UK.
Matern Health Neonatol Perinatol. 2019 Mar 1;5:3. doi: 10.1186/s40748-019-0098-4. eCollection 2019.
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.
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].
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% ( = 0.01) reduction in total mortality (11.39% in stillbirths alone) in the intervention facilities.
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.
世界卫生组织安全分娩检查表（SCC）是一种基于机构的提醒工具，专注于基本护理，以提高产时护理质量。我们旨在评估在印度拉贾斯坦邦使用SCC工具的一揽子干预措施对机构内死产（SBs）和极早期新生儿死亡（vENDs）的影响。
在一个准实验框架内，根据年分娩量匹配选择地区作为干预组或对照组。在七个干预地区的所有区级和县级卫生设施引入SCC工具，随后进行每月一次的支持性监督访问。此外，在所有设施中促进药品和设备的供应（2013 - 2015年）。对照地区的设施提供常规护理。分析仅包括设有专门新生儿护理单元的设施，并从机构登记册收集所有分娩的信息。主要结局是机构内死产和极早期新生儿死亡（出生后3天内）的综合情况。我们使用广义估计方程和泊松回归模型，将时间作为线性项，并在模型中对机构类型进行调整，以估计干预的效果。[ClinicalTrials.gov：NCT01994304]
19个干预设施记录了77239例分娩，15个对照设施记录了59800例分娩。干预设施报告了1621例死产和505例极早期新生儿死亡，而对照设施报告了1390例死产和420例极早期新生儿死亡（相对风险0.89，置信区间0.81，0.97）。这意味着干预设施的总死亡率降低了11.16%（P = 0.01）（仅死产率降低了11.39%）。
我们的结果表明，SCC项目是一项有效的干预措施，每年有可能避免印度40000例产时死亡，其中大部分减少来自死产的预防。
