Obstetric and Perinatal Complications, Postpartum Hemorrhage, Preeclampsia/Eclampsia, Obstructed/Prolonged Labor, Sepsis, Birth Asphyxia
Conditions
Keywords
provider skill and self-efficacy, Appropriate and timely referral for obstetric emergencies, Intervention feasibility and acceptability
Brief summary
To evaluate the effectiveness of a First Referral Unit (FRU) Emergency Obstetric and Newborn Care (EmONC) skills and drills intervention, to estimate the appropriateness and effectiveness of referrals in intervention arm compared to control arm and to calculate the incremental cost and cost effectiveness of EmONC skills and drills intervention.
Detailed description
The aim of this intervention is to improve the quality of care for institutional births with a special focus on improving the quality of Emergency Obstetric and Newborn Care (EmONC). This intervention will focus on improving the skills and practices of providers and through the improvement of referral networks, ensure timely and appropriate management of complications. The specific objectives include: 1. Evaluate the effectiveness of an FRU-level Basic and EmONC Skills and Drills intervention combined with the existing primary health centre (PHC) based nurse mentoring intervention in improving appropriate diagnosis and management of obstetric and perinatal complications. 2. Assess the additional benefit of the EmONC Skills and drills intervention at FRUs in terms of improvement of obstetric and perinatal outcomes compared to the PHC-level intervention alone. 3. Estimate the appropriateness and effectiveness of referrals in intervention facilities compared to controls. 4. Calculate the incremental cost and cost-effectiveness of the EmONC skills and drills intervention
Interventions
OTHERSkills training
Refresher training on Basic Emergency Obstetric and Newborn care
OTHEREmergency obstetric drills
Emergency obstetric drills to practice timely and appropriate management of postpartum hemorrhage and preeclampsia/eclampsia
OTHERRevised Case Sheets
Revised case sheets will be introduced to capture the timing and appropriate medical treatment of women in labor and newborns
Quarterly supportive supervision visits each of the intervention first referral units.
OTHERReferral strengthening
To support referral systems that ensure timely and appropriate treatment for obstetric emergencies
Sponsors
St. John's Research Institute
Maternal Health Task Force
Bill and Melinda Gates Foundation
Karnataka Health Promotion Trust
Harvard School of Public Health (HSPH)
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
All women age who are referred or admitted directly to the first referral unit for a delivery or with a complication Staff working in the First Referral Units
Exclusion criteria
no specific
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Appropriate management of direct obstetric and perinatal complications | Month 18 of the project | Appropriate and timely management of postpartum hemorrhage (PPH), Preeclampsia, Obstructed or prolonged labor, Sepsis and birth asphyxia |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acceptability of the intervention | Month 18 of the project | Using in-depth interviews with providers, we will assess the acceptability of the interventions. |
| Self-efficacy of health care personnel to manage direct obstetric and neonatal complications | Month 18 of the project | Providers will be assessed on self-efficacy pre and post intervention |
| Feasibility of the intervention | Month 18 of the project | We will evaluate barriers and facilitators of implementing these intervention packages, as well as costing them. |
| Case-fatality rates | Month 18 of the project | Using data from obstetric and newborn case sheets we will assess case-fatality rates |
| Timeliness and appropriateness of referral | Month 18 of the project | — |
| Knowledge and skills competency of health care personnel on the management of obstetric and neonatal complications | Month 18 of the project | — |
Outcome results
None listed