Quality improvement package reduces stillbirth and newborn mortality in Kenya and Uganda
Preterm birth remains a major contributor to infant mortality, accounting for more than a third of newborn deaths globally. Reductions in stillbirth and newborn mortality have been slow, leaving an urgent need for new approaches. The time during labor and delivery and right after a baby is born provide the greatest opportunity to save the most lives. However, uptake of evidence-based practices is low because of factors such as health system bottlenecks, inadequate provider training, and overall low quality of care.
In a new study, the East Africa Preterm Birth Initiative tested an intervention package they developed with an emphasis on preterm birth to determine if an integrated approach could reduce the combined rate of stillbirth and newborn mortality among preterm and low-birthweight infants in Kenya and Uganda. The package of interventions sought to reinforce evidence-based practices and increase awareness and consistent use of such practices. It consisted of four components:
- Strengthening data from a maternity register,
- Using locally modified WHO Safe Childbirth Checklist to enhance preterm birth identification and management,
- Quality improvement collaboratives based on the Institute for Healthcare Improvement model, and
- An adapted PRONTO International obstetric and newborn simulation and team training curriculum modified for preterm birth.
Half of the sites implemented all four components of the package, and the other half introduced only the first two components. The researchers found that stillbirth and newborn mortality among low-birthweight and preterm babies were significantly decreased when the whole intervention package was introduced. Perinatal mortality and pre-discharge newborn mortality were also found to be lower at the facilities where all four components were introduced.
The researchers believe their intervention was effective because it worked to increase awareness and consistent use of practices known to improve outcomes. They used locally relevant strategies that targeted provider skills, knowledge and experience and helped overcome weaknesses and bottlenecks in the system. Researchers direct future studies to explore the long-term health impacts of the package as well as focusing on replicating this intervention in different locations and contexts.