Risk Factors for Stillbirth: Findings from a Population-Based Case-Control Study, Haryana, India.

BACKGROUND: Stillbirth is a prevalent adverse outcome of pregnancy in India despite efforts to improve care of women during pregnancy. Risk factors for stillbirths include sociodemographic factors, medical complications during pregnancy, intake of harmful drugs, and complications during delivery. The objective of the study was to examine the risk factors for stillbirth with a focus on sex selection drugs (SSDs). METHODS: A population-based case-control study was undertaken in Haryana. Cases of stillbirths were identified from the Maternal Infant Death Review System portal of Haryana state for the months of August-September 2014. A consecutive birth from the same geographical area as the case was selected as the control. The sample size was 325 per group. Mothers were interviewed using a validated tool. Bivariate analyses and logistic regression were conducted to examine the association between risk factors and stillbirth. Attributable risk proportions (ARP) and population attributable risk proportions (PARP) were estimated. RESULTS: The sociodemographic profiles of the cases and controls were similar. History of intake of SSDs [adjusted odds ratio (OR) 2.6, 95% confidence interval (CI) 1.5, 4.5] emerged as a risk factor. Other significant factors were preterm <37 weeks (OR 3.5, 95% CI 2.1, 6.0), history of previous stillbirths (OR 4.0, 95% CI 2.1, 7.8), and complications during labour (OR 3.3, 95% CI 2.1, 5.3). Estimates of the ARP and PARP for intake of SSDs were 0.60 (95% CI 0.32, 0.77) and 0.1 (95% CI -0.13, 0.28), respectively. CONCLUSIONS: SSDs could be attributed as a risk factor in a fifth of the cases of stillbirths. The number needed to harm for the use of SSDs in causing adverse effect of stillbirths was 5, suggesting thereby that for every five mothers exposed to SSDs, one would have stillbirth. Greater efforts are required to inform people about the harmful effects of SSD consumption during pregnancy.

Computer tablet-based health technology for strengthening maternal and child tracking in Bihar.

BACKGROUND: UNICEF along with the State Government of Bihar launched a computer tablet-based Mother and Child Tracking System (MCTS) in 2014, to capture real-time data online and to minimize the challenges faced with the conventional MCTS. OBJECTIVE: The article reports the process of implementation of tablet-based MCTS in Bihar. METHODS: In-depth interviews with medical officers, program managers, data managers, auxiliary nurse midwives (ANMs), and a monitoring and evaluation specialist were conducted in October 2015 to understand the process of implementation, challenges and possibility for sustainability, and scale-up of the innovation. RESULTS: MCTS innovation was introduced initially in one Primary Health Centre each in Gaya and Purnia districts. The device, supported with Android MCTS software and connected to a dummy server, was given to ANMs. ANMs were trained in its application. The innovation allows real-time data entry, instant uploading, and generation of day-to-day work plans for easy tracking of beneficiaries for providing in-time health-care services. The nonlinking of the dummy server to the national MCTS portal has not lessened the burden of data entry operators, who continue to enter data into the national portal as before. CONCLUSION: The innovation has been successfully implemented to meet its objective of tracking the beneficiaries. The national database should be linked to the dummy server or visible impact. The model is sustainable if the challenges can be met. Mobile technology offers a tremendous opportunity to strengthen the capacity of frontline workers and clinicians and increase the quality, completeness, and timeliness of delivery of critical health services.

Mobile-based effective vaccine management tool: An m-health initiative implemented by UNICEF in Bihar.

BACKGROUND: UNICEF launched the mobile-based Effective Vaccine Management (EVM) system in Bihar in 2014 along with the state government to electronically capture information and identify gaps in the existing vaccine management system for appropriate action. OBJECTIVE: This study accessed the implementation process of this initiative. METHODS: Quantitative data related to vaccine supply chain management indicators were collected in November-December 2015 using factsheets and dashboards, representing the situation of the vaccine supply and cold chain management system at regular intervals since the launch. In-depth interviews were conducted with the program specialists to understand the initiative's genesis, its challenges and strengths. RESULTS: This initiative resulted in an increased cold chain space from 49% (July 2014) to 87% (September 2015), deployment of sufficient human resource; 38 cold chain technicians for regular maintenance of the machines and equipment, installation of necessary equipment, and upgradation of state and regional vaccine stores. In health facilities, district vaccine stores, and regional vaccine stores, marked improvements were observed in the overall EVM criteria indicators (82%, 84%, and 80% in September 2015, respectively, as against 51%, 46%, and 43% in July 2014, respectively) as well as EVM category indicators (83%, 84%, and 76% in September 2015, respectively, as compared to 54%, 53%, and 54% in July 2014, respectively). CONCLUSION: The EVM mobile initiative was successfully implemented and it complies with its objective of providing experienced guidance to the human resource responsible for vaccine cold chain management. The initiative is scalable and its sustainability depends on its thoughtful merger with the existing immunization ecosystem.

Using nonpneumatic anti-shock garment for postpartum hemorrhage management and referral at the public health facilities: A pilot study in two districts of Bihar.

BACKGROUND: Nonpneumatic anti-shock garment (NASG) is a first-aid device that can save lives of women experiencing postpartum hemorrhage (PPH). OBJECTIVE: The aim was to explore the feasibility of implementation of NASG intervention at select public health primary care facilities in two high priority districts of Bihar. METHODS: Qualitative design was used to document the NASG implementation process. In-depth interviews were conducted with health-care providers in November-December 2015. These healthcare providers were chosen purposively based on their involvement in the use of NASG. The implementation process of NASG, process of training for its use, challenges faced during the rollout of implementation and the recommendations for improving the implementation were explored. RESULTS: Initially, a baseline study was conducted to assess the knowledge and skills of health-care providers regarding diagnosis and management of PPH. Implementation consisted of orientation and training of service providers on the identification of PPH cases and usage of the NASG garment during referrals. The interviews with stakeholders reflected that even after training and appropriate introduction of the practice of using the NASG bag, the initiative did not make a difference in ameliorating the situation of PPH management in the health facilities over 6 months. CONCLUSION: This study provides lessons for implementation and scaling up of NASG in public health systems, not only in Bihar but also other similar settings. It also calls for robust implementation research studies to generate evidence on the use of NASG at the primary health-care facilities as an intervention in program settings.