Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial
| العنوان: | Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial |
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| المؤلفون: | Preterm Birth Initiative Kenya, Paul Mubiri, Gertrude Namazzi, Lara Miller, Nancy L. Sloan, Kevin Achola, Dilys Walker, Peter Waiswa, Rikita Merai, Christopher Otare, Phelgona Otieno, Nicole Santos, Elizabeth Butrick, Rakesh Ghosh |
| المصدر: | The Lancet Global Health, Vol 8, Iss 8, Pp e1061-e1070 (2020) The Lancet. Global Health |
| بيانات النشر: | Elsevier, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | medicine.medical_specialty, 030231 tropical medicine, Psychological intervention, Disease cluster, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Pregnancy, law, Infant Mortality, Peripartum Period, Birth Weight, Humans, Medicine, Childbirth, Uganda, 030212 general & internal medicine, Adverse effect, Developing Countries, business.industry, Obstetrics, lcsh:Public aspects of medicine, Infant, Newborn, Infant, Gestational age, lcsh:RA1-1270, General Medicine, Odds ratio, Stillbirth, Kenya, Quality Improvement, Checklist, Female, business |
| الوصف: | Summary Background Although gains in newborn survival have been achieved in many low-income and middle-income countries, reductions in stillbirth and neonatal mortality have been slow. Prematurity complications are a major driver of stillbirth and neonatal mortality. We aimed to assess the effect of a quality improvement package for intrapartum and immediate newborn care on stillbirth and preterm neonatal survival in Kenya and Uganda, where evidence-based practices are often underutilised. Methods This unblinded cluster-randomised controlled trial was done in western Kenya and eastern Uganda at facilities that provide 24-h maternity care with at least 200 births per year. The study assessed outcomes of low-birthweight and preterm babies. Eligible facilities were pair-matched and randomly assigned (1:1) into either the intervention group or the control group. All facilities received maternity register data strengthening and a modified WHO Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. Liveborn or fresh stillborn babies who weighed between 1000 g and 2500 g, or less than 3000 g with a recorded gestational age of less than 37 weeks, were included in the analysis. We abstracted data from maternity registers for maternal and birth outcomes. Follow-up was done by phone or in person to identify the status of the infant at 28 days. The primary outcome was fresh stillbirth and 28-day neonatal mortality. This trial is registered with ClinicalTrials.gov , NCT03112018 . Findings Between Oct 1, 2016, and April 30, 2019, 20 facilities were randomly assigned to either the intervention group (n=10) or the control group (n=10). Among 5343 eligible babies in these facilities, we assessed outcomes of 2938 newborn and fresh stillborn babies (1447 in the intervention and 1491 in the control group). 347 (23%) of 1491 infants in the control group were stillborn or died in the neonatal period compared with 221 (15%) of 1447 infants in the intervention group at 28 days (odds ratio 0·66, 95% CI 0·54–0·81). No harm or adverse effects were found. Interpretation Fresh stillbirth and neonatal mortality among low-birthweight and preterm babies can be decreased using a package of interventions that reinforces evidence-based practices and invests in health system strengthening. Funding Bill & Melinda Gates Foundation. |
| اللغة: | English |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0bc4d96fd71eabd9da24e25c5d703c95 http://www.sciencedirect.com/science/article/pii/S2214109X20302321 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....0bc4d96fd71eabd9da24e25c5d703c95 |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |