Rutgers School of Public Health, Piscataway, NJ, USA.
University College Dublin, Dublin, Ireland.
Glob Health Sci Pract. 2021 Dec 21;9(4):777-792. doi: 10.9745/GHSP-D-21-00205. Print 2021 Dec 31.
We evaluated the impact of solar light installation in Ugandan maternity facilities on implementation processes, reliability of light, and quality of intrapartum care.
We conducted a stepped-wedge cluster-randomized trial of the We Care Solar Suitcase, a complete solar electric system providing lighting and power for charging phones and small medical devices, in 30 rural Ugandan maternity facilities with unreliable lighting. Facilities were randomly assigned to receive the intervention in the first or second sequence in a 1:1 ratio. We collected data from June 2018 to April 2019. The intervention was installed in September 2018 (first sequence) and in December 2018 (second sequence). The primary effectiveness outcomes were a 20-item and a 36-item index of quality of intrapartum care, a 6-item index of delays in care provision, and the percentage of deliveries with bright light, satisfactory light, and adequate light.
We observed 1,118 births across 30 facilities. The intervention was successfully installed in 100% of facilities. After installation, the intervention was used in 83% of nighttime deliveries. Before the intervention, providers on average performed 42% of essential care actions and accumulated 76 minutes of delays during nighttime deliveries. After installation, quality increased by 4 percentage points (95% confidence interval [CI]=1,8) and delays in care decreased by 10 minutes (95% CI=-16,-3), with the largest impacts on infection control, prevention of postpartum hemorrhage, and newborn care practices. One year after the end of the trial, 90% of facilities had LED lights in operation and 60% of facilities had all components in operation.
Reliable light is an important driver of timely and adequate health care. Policy makers should invest in renewable energy systems for health facilities; however, even when reliable lighting is present, quality of care may remain low without a broader approach to quality improvements.
我们评估了在乌干达产科设施中安装太阳能灯对实施过程、光照可靠性和分娩期护理质量的影响。
我们对 30 家农村乌干达产科设施进行了一项 We Care Solar Suitcase（一种完整的太阳能发电系统，可为手机和小型医疗设备充电提供照明和电力）的分步楔形集群随机试验，这些设施的照明都不可靠。设施以 1:1 的比例随机分配接受干预的第一或第二顺序。我们收集了 2018 年 6 月至 2019 年 4 月的数据。干预措施于 2018 年 9 月（第一顺序）和 2018 年 12 月（第二顺序）安装。主要有效性结果是 20 项和 36 项分娩期护理质量指数、6 项护理提供延迟指数和明亮灯光、满意灯光和充足灯光的分娩百分比。
我们观察了 30 家机构的 1118 例分娩。干预措施在 100%的设施中成功安装。安装后，干预措施在 83%的夜间分娩中使用。在干预前，提供者平均执行了 42%的基本护理操作，并在夜间分娩期间积累了 76 分钟的延迟。安装后，质量提高了 4 个百分点（95%置信区间[CI]=1，8），护理延迟减少了 10 分钟（95%CI=-16，-3），对感染控制、预防产后出血和新生儿护理实践的影响最大。试验结束一年后，90%的设施仍在运行 LED 灯，60%的设施仍在运行所有组件。
可靠的照明是及时和充足医疗保健的重要驱动因素。政策制定者应投资于卫生设施的可再生能源系统；然而，即使有可靠的照明，如果没有更广泛的质量改进方法，护理质量可能仍然很低。
