Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial.

↓ Direkt till sidans innehåll
↓ Direkt till sidans sekundära innehåll (sidomenyn)

Search: onr:"swepub:oai:gup.ub.gu.se/334135" > Effect of a scaled-...

1 of 1
Previous record
Next record
To hitlist

Details
MARC

KC, Ashish,1982Uppsala universitet,Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa,Institute of Medicine, School of Public Health and Community Medicine,Internationell barnhälsa och nutrition (author)

Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial.

Article/chapterEnglish2019

Publisher, publication year, extent ...

2019-09-09
Public Library of Science (PLoS),2019

Numbers

LIBRIS-ID:oai:gup.ub.gu.se/334135
https://gup.ub.gu.se/publication/334135URI
https://doi.org/10.1371/journal.pmed.1002900DOI
urn:nbn:se:uu:diva-396627urn
http://kipublications.ki.se/Default.aspx?queryparsed=id:142068390URI

Supplementary language notes

Language:English

Part of subdatabase

SwePubSwePub

Classification

Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

Notes

gratis
Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal.We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 ± 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided.These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care.ISRCTN30829654.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin hsv//swe
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskaper hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine hsv//eng
MEDICAL AND HEALTH SCIENCES Health Sciences hsv//eng
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskaper Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
Adult
Female
Hospital Mortality
Hospitals
Public
Humans
Infant
Infant Mortality
Infant
Newborn
Intensive Care Units
Neonatal
Intensive Care
Neonatal
standards
Nepal
Parturition
Perinatal Death
etiology
prevention & control
Pregnancy
Quality Improvement
Quality Indicators
Health Care
Resuscitation
adverse effects
mortality
standards
Risk Factors
Stillbirth
Time Factors
Treatment Outcome
Young Adult

Added entries (persons, corporate bodies, meetings, titles ...)

Ewald, Uwe,1945-Uppsala universitet,Institutionen för kvinnors och barns hälsa(Swepub:uu)uweewald (author)
Basnet, OmkarGolden Community, Jawgal, Lalitpur, Nepal (author)
Gurung, AbhishekGolden Community, Jawgal, Lalitpur, Nepal (author)
Pyakuryal, Sushil NathNepal Hlth Res Council, Kathmandu, Nepal (author)
Jha, Bijay KumarGovt Nepal, Minist Hlth & Populat, Kathmandu, Nepal (author)
Bergström, Anna,1983-Uppsala universitet,Institutionen för kvinnors och barns hälsa,UCL, UCL Inst Global Hlth IGH, London, England(Swepub:uu)annbe648 (author)
Eriksson, Leif,1971-Uppsala universitet,Vårdvetenskap(Swepub:uu)leier888 (author)
Paudel, PrajwalNepal Hlth Res Council, Kathmandu, Nepal (author)
Karki, SushilLife Line Nepal, Kathmandu, Nepal (author)
Gajurel, SunilKamana Hlth Nepal, Kathmandu, Nepal (author)
Brunell, OliviaUppsala universitet,Internationell barnhälsa och nutrition(Swepub:uu)olibr707 (author)
Wrammert, Johan,1974-Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH)(Swepub:uu)johwr369 (author)
Litorp, Helena,1980-Karolinska Institutet,Uppsala universitet,Institutionen för kvinnors och barns hälsa(Swepub:uu)helli994 (author)
Målqvist, Mats,1971-Uppsala universitet,Global hälsa - implementering och hållbarhet(Swepub:uu)matma534 (author)
Göteborgs universitetInstitutionen för medicin, avdelningen för samhällsmedicin och folkhälsa (creator_code:org_t)
Göteborgs universitet
Gothenburg University

Related titles

In:PLoS medicine: Public Library of Science (PLoS)16:91549-16761549-1277

Internet link

Find in a library

PLoS medicine (Search for host publication in LIBRIS)

To the university's database

Uppsala University

1 of 1
Previous record
Next record
To hitlist

Find more in SwePub

By the author/editor: KC, Ashish, 1982; Ewald, Uwe, 1945 ...; Basnet, Omkar; Gurung, Abhishek; Pyakuryal, Sushi ...; Jha, Bijay Kumar; show more...; Bergström, Anna, ...; Eriksson, Leif, ...; Paudel, Prajwal; Karki, Sushil; Gajurel, Sunil; Brunell, Olivia; Wrammert, Johan, ...; Litorp, Helena, ...; Målqvist, Mats, ...; show less...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Health Sciences

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Health Sciences; and Public Health Gl ...

Articles in the publication: PLoS medicine

By the university: University of Gothenburg; Uppsala University

Search outside SwePub

Extend your search to:: Google; Google Book Search; Google Scholar

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

LIBRIS.kb.se