Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India
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Authors
Iyengar, Kirti
Jain, Motilal
Thomas, Sunil
Dashora, Kalpana
Liu, William
Saini, Paramsukh
Parker, Indrani
Iyengar, Sharad
Dattatreya, Rajesh
Issue Date
2014-08-13
Type
Article
Language
en_US
Keywords
Childbirth , Quality of Care , Intrapartum , Evidence Based Delivery Care , Rajasthan , Maternal Care , Perinatal Mortality , Institutional Delivery
Alternative Title
Abstract
Background:
After the launch of Janani Suraksha Yojana, a conditional cash transfer scheme in India, the proportion of women giving birth in institutions has rapidly increased. However, there are important gaps in quality of childbirth services during institutional deliveries. The aim of this intervention was to improve the quality of childbirth services in selected high caseload public health facilities of 10 districts of Rajasthan. This intervention titled “Parijaat” was designed by Action Research & Training for Health, in partnership with the state government and United Nations Population Fund.
Methods:
The intervention was carried out in 44 public health facilities in 10 districts of Rajasthan, India. These included district hospitals (9), community health centres (32) and primary health centres (3). The main intervention was orientation training of doctors and program managers and regular visits to facilities involving assessment, feedback, training and action. The adherence to evidence based practices before, during and after this intervention were measured using structured checklists and scoring sheets. Main outcome measures included changes in practices during labour, delivery or immediate postpartum period.
Results:
Use of several unnecessary or harmful practices reduced significantly. Most importantly, proportion of facilities using routine augmentation of labour reduced (p = 0), episiotomy for primigravidas (p = 0.0003), fundal pressure (p = 0.0003), and routine suction of newborns (0 = 0.0005). Among the beneficial practices, use of oxytocin after delivery increased (p = 0.0001) and the practice of listening foetal heart sounds during labour (p = 0.0001). Some practices did not show any improvements, such as dorsal position for delivery, use of partograph, and hand-washing.
Conclusions:
An intervention based on repeated facility visits combined with actions at the level of decision makers can lead to substantial improvements in quality of childbirth practices at health facilities.
Description
Citation
Iyengar, K., Jain, M., Thomas, S., Dashora, K., Liu, W., Saini, P., Dattatreya, R., Parker, I., & Iyengar, S. (2014). Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India. BMC pregnancy and childbirth, 14, 270. https://doi.org/10.1186/1471-2393-14-270
Publisher
BMC Pregnancy and Childbirth