By: Smita Gaith, Women Deliver
Although many maternal and newborn deaths in developing countries are preventable, they still occur at alarmingly high rates. Whereas in developed countries, the maternal mortality rate is estimated to be 16 maternal deaths per 100,000 live births, developing countries see maternal mortality rates as high as 240 maternal deaths per 100,000 live births.
Recently, the Harvard School of Public Health and The World Health Organization completed a pilot study in Karnatka, India, of a novel intervention to reduce these preventable deaths. The study examined the use of a checklist in improving adherence by health professionals to protocols during child birth.
Out of 29 different practices and protocols measured, the check list was found to improve adherence to 28 practices. According to researchers, there was a 150% improvement in protocol adherence after the checklist was introduced to health workers involved in child birth. These 29 practices targeted the major causes of maternal and neonatal deaths. These included hemorrhage, infection, obstructed labor, and hypertensive disease (all contributors to maternal deaths) and complications of premature birth, infection, and birth asphyxia (all contributors to newborn deaths).
Before implementing the checklist, designed by Harvard School of Public Health and WHO, researchers established baseline levels of protocol adherence and found that on average, 10 of 29 protocols were observed. After implementing the checklist, the number of protocols observed increased to 25. Dr. Bhala Kodkany, professor of obstetrics and gynecology and director of JNMC Women’s and Children’s Health Research Unit in Karnataka, India, commented that the checklist program “…actively prompted health care workers to remember to complete proven practices such as handwashing, infection management, postpartum bleeding assessment, and breastfeeding within an hour after birth.”
The study indicates potentially large-scale benefits of applying the checklist program elsewhere. Itziar Larizgoitia, coordinator in the Patient Safety Programme for WHO, noted that the program represents “…first evidence to suggest that the success we’ve seen with checklists in other health disciplines, for example in surgery, might also be applied to prevent avoidable childbirth-related deaths in low-income countries.”
A large-scale trial in over 100 hospitals in Northern India is now underway to evaluate the checklist program’s ability to save the lives of women and newborns.