Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India

Authors: Kirti Iyengar, Motilal Jain, Sunil Thomas, Kalpana Dashora, William Liu, Paramsukh Saini, Rajesh Dattatreya, Indrani Parker, Sharad Iyengar

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Campbell OMR, Graham WJ: On behalf of The Lancet Maternal Survival Series steering group: strategies for reducing maternal mortality: getting on with what works. Lancet. 2006, 368: 1284-1299.CrossRefPubMed
2.
Mathai M: To ensure maternal mortality is reduced, quality of care needs to be monitored and improved alongside increasing skilled delivery coverage rates. BJOG. 2011, 118 (Suppl 2): 12-14.CrossRefPubMed
3.
Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E: India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet. 2010, 375: 2009-2023.CrossRefPubMed
4.
5.
6.
Registrar General of India: Sample registration system statistical report 2007: report No. 2 ,2008. Office of Registrar General of India, New Delhi. 2008, 41 (1): 1-203.
7.
Randive B, Diwan V, De Costa A: India’s Conditional Cash Transfer Programme (the JSY) to Promote Institutional Birth: Is There an Association between Institutional Birth Proportion and Maternal Mortality?. PLoS One. 2013, 8 (6): e67452-CrossRefPubMedPubMedCentral
8.
Singh SK, Kaur R, Gupta M, Kumar R: Impact of National Rural Health Mission on Perinatal Mortality in Rural India. Indian Pediatr. 2012, 49: 136-138.CrossRefPubMed
9.
Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, Gardosi J, Day LT, Stanton C: Stillbirths 2 Stillbirths: Where? When? Why? How to make the data count?. Lancet. 2011, 377: 1448-1463.CrossRefPubMed
10.
Bhutta ZA, Darmstadt GL, Haws RA, Yakoob MY, Lawn JE: Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand: Review of Strategies. BMC Pregnancy Childbirth. 2009, 9 (Suppl 1): S7-CrossRefPubMedPubMedCentral
11.
Iyengar SD, Iyengar K, Suhalka V: A comparison of domiciliary and institutional delivery practices in rural Rajasthan. India J Health Popul Nutr. 2009, 27 (2): 303-312.PubMed
12.
Iyengar SD, Iyengar K, Martines JC, Dashora K, Deora KK: Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival. J Perinatol. 2008, 28 (Suppl 2): S23-S30.CrossRefPubMed
13.
Brhlikova P, Jeffery P, Bhatia GP, Khurana S: Intrapartum Oxytocin (Mis) use in South Asia. Journal of Health Studies. 2009, 2: 33-50.
14.
15.
Choices and Challenges in Changing Childbirth Research Network: Routines in facility-based maternity care: evidence from the Arab World. BJOG. 2005, 112: 1270-1276.CrossRefPubMedCentral
16.
Shaban IA, Hatamleh R, Khresheh R, Homer C: Childbirth practices in Jordanian public hospitals: consistency with evidence-based maternity care?. Int J Evid Based Healthc. 2011, 9 (1): 25-31.CrossRefPubMed
17.
Khalil K, Cherine M, Elnoury A, Sholkamy H, Breebaart M, Hassanein N: Labor augmentation in an Egyptian teaching hospital. Int J Gynaecol Obstet. 2004, 85 (1): 74-80.CrossRefPubMedPubMedCentral
18.
Dujardin B, Bousten M, De Schampheleire I, Kulker R: Oxytocin in developing countries. Int J Gynecol Reprod Biol. 2005, 122 (1): 40-44.CrossRef
19.
Lovold A, Stanton C, Armbruster D: How to avoid iatrogenic morbidity and mortality while increasing availability of oxytocin and misoprostol for PPH prevention?. Int J Gynaecol Obstet. 2008, 103 (3): 276-282.CrossRefPubMed
20.
Kaye D: Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric care referrals in Mulago hospital, Kampala. Uganda East Afr Med J. 2003, 80 (3): 140-143.PubMed
21.
Manandhar SR, Ojha A, Manandhar DS, Shrestha B, Shrestha D, Saville N, Costello AM, Osrin D: Causes of stillbirths and neonatal deaths in Dhanusha district, Nepal: a verbal autopsy study. Kathmandu Univ Med J (KUMJ). 2010, 8 (29): 62-72.
22.
23.
Goonewardene M, Rameez MFM, Kaluarachchi A, Perera H: WHO recommendations for induction of labour: RHL commentary (last revised: 1 November 2011). 2011, Geneva: The WHO Reproductive Health Library
24.
Carroli G, Belizan J: Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2007, 4: 1-4.
25.
Reveiz L, Gaitán HG, Cuervo LG: Enemas during labour. Cochrane Database Syst Rev. 2013, 7: 1-9.
26.
Wall SN, Lee ACC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL, Keenan W, Bhutta ZA, Perlman J, Lawn JE: Reducing Intrapartum-Related Neonatal Deaths in Low- and Middle-Income Countries—What Works?. Semin Perinatol. 2010, 34: 395-407.CrossRefPubMed
27.
28.
Debra B, Elliott M: Effective implementation strategies and tactics for leading change on maternity units. J Perinat Neonatal Nurs. 2010, 24 (1): 32-42.CrossRef
29.
World Health Organization, United Nations Population Fund, UNICEF, The World Bank: Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice. 2006, Geneva: World Health Organization, 2
30.
Government of India: Guidelines for antenatal care and skilled attendance at birth by ANMs/LHVs/SNs. 2010, Goverment of India: Maternal Health Division, Ministry of Health and Family Welfare
31.
Belizan M, Meier A, Althabe F, Codazzi A, Colomar M, Buekens P, Belizan J, Walsh J, Campbell MK: Facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals: a qualitative study. Health Educ Res. 2007, 22 (6): 839-853.CrossRefPubMed
32.
The SEA-ORCHID, Group S: Use of Evidence-Based Practices in Pregnancy and Childbirth: South East Asia Optimising Reproductive and Child Health in Developing Countries Project. PLoS One. 2008, 3 (7): e2646-CrossRef
33.
Karolinski A, Micone P, Mercer R, Gibbons L, Althabe F, Belizánc JM, Messina A, Lapidus A, Correa A, Taddeo C, Lambruschini R, Bertin M, Dibiase L, Varela DM, Laterra C: And on behalf of the AMBA Perinatal Network Research Group: evidence-based maternal and perinatal healthcare practices in public hospitals in Argentina. Int J Gynecol Obstet. 2009, 105: 118-122.CrossRef
34.
Berglund A, Lefevre-Cholay H, Bacci A, Blyumina A, Lindmark G: Successful implementation of evidence-based routines in Ukrainian maternities. Acta Obstet Gynecol. 2010, 89: 230-237.CrossRef
35.
Turan MT, Bulut A, Nalbant H, Ortayli N, Erbaydar T: Challenges for the adoption of evidence based maternity care in Turkey. Soc Sci Med. 2006, 62: 2196-2204.CrossRefPubMed
36.
Spector JM, Agrawal P, Kodkany B, Lipsitz S, Lashoher A, Dziekan G, Bahl R, Merialdi M, Mathai M, Lemer C, Gawande A: Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program. PLoS One. 2012, 7 (5): e35151-CrossRefPubMedPubMedCentral
37.
Aghlmand S, Akbari F, Lameei A, Mohammad K, Small R, Arab M: Developing evidence-based maternity care in Iran: a quality improvement study. BMC Pregnancy Childbirth. 2008, 8: 20-CrossRefPubMedPubMedCentral
38.
Althabe F, Bergel E, Cafferata ML, Gibbons L, Ciapponi A, Alemán A, Colantonio L, Palacios AR: Strategies for improving the quality of health care in maternal and child health in low- and middle-income countries: an overview of systematic reviews. Paediatr Perinat Epidemiol. 2008, 22 (Suppl. 1): 42-60.CrossRefPubMed
39.
Hovlid E, Bukve O, Haug K, Aslaksen AB, von Plessen C: Sustainability of healthcare improvement: what can we learn from learning theory?. BMC Health Serv Res. 2012, 12: 235-CrossRefPubMedPubMedCentral
40.
41.
42.
Mullen PM: Using performance indicators to improve performance. Health Serv Manage Resour. 2004, 17: 217-228.CrossRef
43.
Gibberd R, Hancock S, Howley P, Richards K: Using indicators to quantify the potential to improve the quality of health care. Int J Qual Health Care. 2004, 16 (Suppl. 1): i37-i43.CrossRefPubMed
44.
Bhattacharyya S, Srivastava A, Avan BI, Graham WJ: Quality care at childbirth in the context of Health Sector Reform Program in India: Contributing factors, Challenges and Implementation Lessons. Health Systems and Policy Res. 2012, 1 (1): 2-
Metadata
Title
Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India
Authors
Kirti Iyengar
Motilal Jain
Sunil Thomas
Kalpana Dashora
William Liu
Paramsukh Saini
Rajesh Dattatreya
Indrani Parker
Sharad Iyengar
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-270

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue

Research article

Indirect cost of maternal deaths in the WHO African Region in 2010

Research article

Food choices and practices during pregnancy of immigrant women with high-risk pregnancies in Canada: a pilot study

Reviewer acknowledgement

Reviewer acknowledgement 2013

Research article

Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania

Research article

Effect of education and clinical assessment on the accuracy of post partum blood loss estimation

Research article

Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study