A Step Towards Lowering Maternal Mortality: Adoption of Elements of WHO’s Safe Childbirth Checklist at A Tertiary Care Hospital of Rawalpindi, Pakistan: A Cross-Sectional Survey

Saira Maroof; Zubaida Rashid; Imtenan Sharif; Marukh Alam; Rida Nawaz; Salman Nawaz; Maaz Amin; Naseer ul Islam; Syed Irshad Hussain; Aimal Khan

doi:10.37978/tijfs.v3i2.53

Authors

Saira Maroof AD Training Medical Directorate, ACAS (MS) Secretariat AHQ, Peshawar, Pakistan Author
Zubaida Rashid Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan Author
Imtenan Sharif Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan Author
Marukh Alam Army Medical College, Rawalpindi, Pakistan Author
Rida Nawaz Army Medical College, Rawalpindi, Pakistan Author
Salman Nawaz Army Medical College, Rawalpindi, Pakistan Author
Maaz Amin Army Medical College, Rawalpindi, Pakistan Author
Naseer ul Islam Army Medical College, Rawalpindi, Pakistan Author
Syed Irshad Hussain Army Medical College, Rawalpindi, Pakistan Author
Aimal Khan Army Medical College, Rawalpindi, Pakistan Author

DOI:

https://doi.org/10.37978/tijfs.v3i2.53

Keywords:

WHO, Safe Child birth checklist, MMR, Pakistan

Abstract

Background: Use of the World Health Organization’s (WHO) Safe Childbirth Checklist (SCC) has been associated with a significant reduction of maternal mortality.

Method: A descriptive cross-sectional survey conducted at a tertiary care hospital of Rawalpindi in labour room and postnatal ward from February 2018 to July 2018. A sample size of 359 was estimated using WHO sample size calculator and were enrolled using purposive sampling technique. A close ended WHO standardized questionnaire covering the 22 elements of WHO SCC was used. Frequencies and percentages were documented of variables and data was analysed using SPSS version 23.

Results: Mean age of participants was 27 ± 4.25 years. On admission, it was observed that being centre of excellence and referral, there was 100% availability of gloves and supplies to clean hands before and after each vaginal examination. Just before pushing or caesarean, it was found that in 342 (95.3%) patients, assistant was identified to help at time of birth. Immediately after one hour of birth, it was noted that 79 (22%) patients were bleeding abnormally and were immediately addressed. We also found out that only 79 (22%) of the mothers were counselled regarding family planning. Almost half of the participant mothers 182 (50.7%) or their companions were counselled regarding danger signs and to seek care immediately which should have been 100%.

Conclusion: Excellent adoption of some of the element up to 100% was observed while some of the elements of checklist were poorly adopted; noticeable was counselling regarding family planning options immediate postpartum.

References

Reddy KS. Global Burden of Disease Study 2015 provides GPS for global health 2030. The Lancet. 2016 Oct 8;388(10053):1448-9.

Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet. 2016 Jan 30;387(10017):462-74.

Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, Sankar MJ, Blencowe H, Rizvi A, Chou VB, Walker N. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. The Lancet. 2014 Jul 26;384(9940):347- 70.

Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, Van Den Broek N. Causes of and factors associated with stillbirth in low-and middle-income countries: a systematic literature review. BJOG: An International Journal of Obstetrics & Gynaecology. 2014 Sep;121:141-53.

Spector JM, Lashoher A, Agrawal P, Lemer C, Dziekan G, Bahl R, Mathai M, Merialdi M, Berry W, Gawande AA. Designing the WHO Safe Childbirth Checklist program to improve quality of care at childbirth. International Journal of Gynecology & Obstetrics. 2013 Aug;122(2):164-8.

World Health Organization. Quality of care: a process for making strategic choices in health systems,2006.

Dettrick Z, Firth S, Soto EJ. Do strategies to improve quality of maternal and child health care in lower and middle income countries lead to improved outcomes? A review of the evidence. PLoS One. 2013 Dec 9;8(12):e83070.

Salam RA, Mansoor T, Mallick D, Lassi ZS, Das JK, Bhutta ZA. Essential childbirth and postnatal interventions for improved maternal and neonatal health. Reproductive Health. 2014 Aug;11(1):S3.

Kumar S, Yadav V, Balasubramaniam S, et al. Effectiveness of the WHO SCC on improving adherence to essential practices during childbirth, in resource constrained settings. BMC Pregnancy Childbirth 2016;16:345-345

Spector JM, Lashoher A, Agrawal P, Lemer C, Dziekan G, Bahl R, Mathai M, Merialdi M, Berry W, Gawande AA. Designing the WHO Safe Childbirth Checklist program to improve quality of care at childbirth. International Journal of Gynecology & Obstetrics. 2013 Aug;122(2):164-8.

Patabendige M, Senanayake H. Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience. BMC pregnancy and childbirth. 2015 Dec;15(1):12.

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 May 16;7(5):e35151.

Nababan HY, Islam R, Mostari S, Tariqujjaman M, Sarker M, Islam MT, Moucheraud C. Improving quality of care for maternal and newborn health: a pre- post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh. BMC pregnancy and childbirth. 2017 Dec;17(1):402.

Patabendige M, Senanayake H. Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience. BMC pregnancy and childbirth. 2015 Dec;15(1):12.

Nababan HY, Islam R, Mostari S, Tariqujjaman M, Sarker M, Islam MT, Moucheraud C. Improving quality of care for maternal and newborn health: a pre- post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh. BMC pregnancy and childbirth. 2017 Dec;17(1):402.

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 May 16;7(5):e35151.

Perry WR, Nejad SB, Tuomisto K, Kara N, Roos N, Dilip TR, Hirschhorn LR, Larizgoitia I, Semrau K, Mathai M, Dhingra-Kumar N. Implementing the WHO Safe Childbirth Checklist: lessons from a global collaboration. BMJ global health. 2017 Aug 1;2(3):e000241.

Delaney MM, Maji P, Kalita T, Kara N, Rana D, Kumar K, Masoinneuve J, Cousens S, Gawande AA, Kumar V, Kodkany B. Improving adherence to essential birth practices using the WHO safe childbirth checklist with peer coaching: experience from 60 public health facilities in Uttar Pradesh, India. Global Health: Science and Practice. 2017 Jun 27;5(2):217-31.

Semrau KE, Hirschhorn LR, Marx Delaney M, Singh VP, Saurastri R, Sharma N, Tuller DE, Firestone R, Lipsitz S, Dhingra-Kumar N, Kodkany BS. Outcomes of a coaching-based WHO safe childbirth checklist program in India. New England Journal of Medicine. 2017 Dec 14;377(24):2313-24.