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1.
BMC Public Health ; 18(1): 892, 2018 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021547

RESUMO

BACKGROUND: A strong evidence base exists regarding routine and emergency services that can effectively prevent or reduce maternal and new-born mortality. However, even when skilled providers care for women in labour, many of the recommended services are not provided, despite being available. Barriers to the provision of appropriate childbirth services may include lack of availability of supplies, limited health worker knowledge and confidence, or inadequate time. The WHO Safe Childbirth Checklist (SCC) includes reminders for evidenced-based practices at specific points in the childbirth process. Zambia is currently considering nation-wide adoption of the SCC, but there is a need for context-specific evidence. Beginning in September 2017, a program is being implemented in Nchelenge District to pilot use of the SCC, along with coaching that focuses on strengthening the systems that allow the essential practices in childbirth to be performed. METHODS: This study will use a pre-post study design to measure health worker adherence to the essential practices for delivery care outlined in the SCC. Data will be collected through observations of health workers as they care for mothers during childbirth at four facilities. Data collection will take place before the start of the intervention, at 3 months, and at 6 months post-intervention. The primary outcome interest is the change in the average proportion of essential childbirth practices completed. A health worker questionnaire will be administered at the time that the SCC is introduced and 6 months later to gather their perspectives on incorporating the SCC into clinical practice in Zambia. DISCUSSION: Findings are expected to inform plans for introducing the SCC in Zambia. This evaluation will aim to understand uptake and impact of the SCC and associated coaching in the context of a basic level of mentorship that the government could feasibly provide at a national scale. TRIAL REGISTRATION: Clinical Trials.gov ( NCT03263182 ) Registered August 28, 2017.


Assuntos
Lista de Checagem , Parto Obstétrico , Fidelidade a Diretrizes , Pessoal de Saúde , Parto Obstétrico/normas , Feminino , Humanos , Saúde do Lactente , Recém-Nascido , Saúde Materna , Tutoria , Segurança do Paciente , Gravidez , Inquéritos e Questionários , Zâmbia
2.
PLoS One ; 15(12): e0244310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378372

RESUMO

Although strong evidence exists about the effectiveness of basic childbirth services in reducing maternal and newborn mortality, these services are not provided in every childbirth, even those at health facilities. The WHO Safe Childbirth Checklist (SCC) was developed as a job aide to remind health workers of evidenced-based practices to be provided at specific points in the childbirth process. The Zambian government requested context-specific evidence on the feasibility and outcomes associated with introducing the checklist and related mentorship. A study was conducted on use of the SCC in four facilities in Nchelenge District of Zambia. Observations of childbirth services were conducted just before and six months after the introduction of the intervention. Observers used a structured tool to record adherence to essential services indicated on the checklist. The primary outcome of interest was the change in the average proportion of essential childbirth practices completed. Feedback questionnaires were administered to health workers before and six months after the intervention. At baseline and endline, 108 and 148 pause points were observed, respectively. There was an increase from 57% to 76% of tasks performed (p = 0.04). Considering only these cases where necessary supplies were available, health workers completed 60% of associated tasks at baseline compared to 84% at endline (p<0.01). Some tasks, such as taking an infant's temperature and hand washing, were never or rarely performed at baseline. Feedback from the health workers indicated that nearly all health workers agreed or strongly agreed with positive statements about the intervention. The performance of health workers in Zambia in completing essential practices in childbirth was low at baseline but improvements were observed with the introduction of the SCC and mentorship. Our results suggest that such interventions could improve quality of care for facility-based childbirth. However, national-level commitment to ensuring availability of trained staff and supplies is essential for success. Trial registration Clinical Trials.gov (NCT03263182) Registered August 28, 2017 This study adheres to CONSORT guidelines.


Assuntos
Lista de Checagem/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Educação Pré-Natal/métodos , Adulto , Lista de Checagem/estatística & dados numéricos , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Feminino , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde , Humanos , Masculino , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Parto/psicologia , Gravidez , Melhoria de Qualidade , Inquéritos e Questionários , Organização Mundial da Saúde , Zâmbia/epidemiologia
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