Quality Improvement Approaches Associated with Quality of Childbirth Care Practices in Six Indian States.

OBJECTIVE

To compare the impact of quality improvement (QI) approaches and other health system factors (level of health facility, cadre of staff conducting the delivery, years of experience of staff conducting the delivery, and time of day) on the quality of six elements of delivery and postpartum/postnatal care.

DESIGN

Cross-sectional study using external observers.

SETTING

12 public health facilities in 6 states in India during November 2014.

PARTICIPANTS/PATIENTS: 461 deliveries in above facilities.

INTERVENTION: Facilities were chosen based on having received one day of QI training and at least six monthly QI coaching visits.

MAIN OUTCOME MEASURE(S): (i) Administration of oxytocin within one minute following delivery, (ii) immediate drying and wrapping of the newborn, (iii) use of sterile cord clamps, (iv) breastfeeding within one hour of birth, (v) mothers' condition assessed between 0 and 30 minute after delivery, and (vi) vitamin K given to infants within 6 hour of birth.

RESULTS

On multivariate analysis, facilities using QI approaches with deliberate aims to address the processes of interest were more likely to dry and wrap infants (OR 2.6, 95% CI: 2.1, 6.6), initiate early breastfeeding (OR 3.6, 95% CI: 2.1, 6.2) and conduct post-partum vitals monitoring (OR 2.7, 95% CI: 1.7, 4.2). The other health system factors had mixed effects.

CONCLUSIONS

Facilities using QI approaches to ensure all women and babies receive specific elements of care provide that element of care to a greater proportion than facilities not using QI approaches for that element of care.