To evaluate the effectiveness of a First Referral Unit (FRU) Emergency Obstetric and Newborn Care (EmONC) skills and drills intervention, to estimate the appropriateness and effectiveness of referrals in intervention arm compared to control arm and to calculate the incremental cost and cost effectiveness of EmONC skills and drills intervention.
The aim of this intervention is to improve the quality of care for institutional births with a special focus on improving the quality of Emergency Obstetric and Newborn Care (EmONC). This intervention will focus on improving the skills and practices of providers and through the improvement of referral networks, ensure timely and appropriate management of complications. The specific objectives include: 1. Evaluate the effectiveness of an FRU-level Basic and EmONC Skills and Drills intervention combined with the existing primary health centre (PHC) based nurse mentoring intervention in improving appropriate diagnosis and management of obstetric and perinatal complications. 2. Assess the additional benefit of the EmONC Skills and drills intervention at FRUs in terms of improvement of obstetric and perinatal outcomes compared to the PHC-level intervention alone. 3. Estimate the appropriateness and effectiveness of referrals in intervention facilities compared to controls. 4. Calculate the incremental cost and cost-effectiveness of the EmONC skills and drills intervention
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
15,018
Refresher training on Basic Emergency Obstetric and Newborn care
Emergency obstetric drills to practice timely and appropriate management of postpartum hemorrhage and preeclampsia/eclampsia
Revised case sheets will be introduced to capture the timing and appropriate medical treatment of women in labor and newborns
Quarterly supportive supervision visits each of the intervention first referral units.
To support referral systems that ensure timely and appropriate treatment for obstetric emergencies
Appropriate management of direct obstetric and perinatal complications
Appropriate and timely management of postpartum hemorrhage (PPH), Preeclampsia, Obstructed or prolonged labor, Sepsis and birth asphyxia
Time frame: Month 18 of the project
Feasibility of the intervention
We will evaluate barriers and facilitators of implementing these intervention packages, as well as costing them.
Time frame: Month 18 of the project
Acceptability of the intervention
Using in-depth interviews with providers, we will assess the acceptability of the interventions.
Time frame: Month 18 of the project
Self-efficacy of health care personnel to manage direct obstetric and neonatal complications
Providers will be assessed on self-efficacy pre and post intervention
Time frame: Month 18 of the project
Knowledge and skills competency of health care personnel on the management of obstetric and neonatal complications
Time frame: Month 18 of the project
Case-fatality rates
Using data from obstetric and newborn case sheets we will assess case-fatality rates
Time frame: Month 18 of the project
Timeliness and appropriateness of referral
Time frame: Month 18 of the project
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