Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth)
Summary: Background: A coaching-based implementation of the WHO Safe Childbirth Checklist in Uttar Pradesh, India, improved adherence to evidence-based practices, but did not reduce perinatal mortality, maternal morbidity, or maternal mortality. We examined facility-level correlates of the outcomes...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2019-08-01
|
Series: | The Lancet Global Health |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X1930261X |
id |
doaj-5e6e91ff71d7490c9131aa95a831b1bd |
---|---|
record_format |
Article |
spelling |
doaj-5e6e91ff71d7490c9131aa95a831b1bd2020-11-25T02:33:01ZengElsevierThe Lancet Global Health2214-109X2019-08-0178e1088e1096Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth)Megan Marx Delaney, MSN0Kate A Miller, PhD1Lauren Bobanski, MPH2Shambhavi Singh, MPH3Vishwajeet Kumar, MD4Ami Karlage, BA5Danielle E Tuller, MHS6Atul A Gawande, ProfMD7Katherine E A Semrau, PhD8Ariadne Labs, Boston, MA, USAAriadne Labs, Boston, MA, USAAriadne Labs, Boston, MA, USACommunity Empowerment Lab, Lucknow, IndiaCommunity Empowerment Lab, Lucknow, IndiaAriadne Labs, Boston, MA, USAAriadne Labs, Boston, MA, USAAriadne Labs, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USAAriadne Labs, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Correspondence to: Dr Katherine Semrau, Ariadne Labs, Brigham and Women's Hospital, Harvard T H Chan School of Public Health, Boston, MA 02215, USASummary: Background: A coaching-based implementation of the WHO Safe Childbirth Checklist in Uttar Pradesh, India, improved adherence to evidence-based practices, but did not reduce perinatal mortality, maternal morbidity, or maternal mortality. We examined facility-level correlates of the outcomes, which varied widely across the 120 study facilities. Methods: We did a post-hoc analysis of the coaching-based implementation of the WHO Safe Childbirth Checklist in Uttar Pradesh. We used multivariable modelling to identify correlations between 30 facility-level characteristics and each health outcome (perinatal mortality, maternal morbidity, or maternal mortality). To identify contexts in which the intervention might have had an effect, we then ran the models on data restricted to the period of intensive coaching and among patients not referred out of the facilities. Findings: In the multivariable context, perinatal mortality was associated with only 3 of the 30 variables: female literacy at the district level, geographical location, and previous neonatal mortality. Maternal morbidity was only associated with geographical location. No facility-level predictors were associated with maternal mortality. Among facilities in the lowest tertile of birth volume (<95 births per month), our models estimated perinatal mortality was 17 (95% CI 11·7–24·8) per 1000 births in the intervention group versus 38 (31·6–44·8) per 1000 in the control group (p<0·0001). Interpretation: Mortality was not directly associated with measured facility-level indicators but was associated with general risk factors. The absence of correlation between expected predictors and patient outcomes and the association between improved outcomes and the intervention in smaller facilities suggest a need for additional measures of quality of care that take into account complexity. Funding: Bill & Melinda Gates Foundation.http://www.sciencedirect.com/science/article/pii/S2214109X1930261X |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Megan Marx Delaney, MSN Kate A Miller, PhD Lauren Bobanski, MPH Shambhavi Singh, MPH Vishwajeet Kumar, MD Ami Karlage, BA Danielle E Tuller, MHS Atul A Gawande, ProfMD Katherine E A Semrau, PhD |
spellingShingle |
Megan Marx Delaney, MSN Kate A Miller, PhD Lauren Bobanski, MPH Shambhavi Singh, MPH Vishwajeet Kumar, MD Ami Karlage, BA Danielle E Tuller, MHS Atul A Gawande, ProfMD Katherine E A Semrau, PhD Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth) The Lancet Global Health |
author_facet |
Megan Marx Delaney, MSN Kate A Miller, PhD Lauren Bobanski, MPH Shambhavi Singh, MPH Vishwajeet Kumar, MD Ami Karlage, BA Danielle E Tuller, MHS Atul A Gawande, ProfMD Katherine E A Semrau, PhD |
author_sort |
Megan Marx Delaney, MSN |
title |
Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth) |
title_short |
Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth) |
title_full |
Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth) |
title_fullStr |
Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth) |
title_full_unstemmed |
Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth) |
title_sort |
unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the who safe childbirth checklist in uttar pradesh, india (betterbirth) |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2019-08-01 |
description |
Summary: Background: A coaching-based implementation of the WHO Safe Childbirth Checklist in Uttar Pradesh, India, improved adherence to evidence-based practices, but did not reduce perinatal mortality, maternal morbidity, or maternal mortality. We examined facility-level correlates of the outcomes, which varied widely across the 120 study facilities. Methods: We did a post-hoc analysis of the coaching-based implementation of the WHO Safe Childbirth Checklist in Uttar Pradesh. We used multivariable modelling to identify correlations between 30 facility-level characteristics and each health outcome (perinatal mortality, maternal morbidity, or maternal mortality). To identify contexts in which the intervention might have had an effect, we then ran the models on data restricted to the period of intensive coaching and among patients not referred out of the facilities. Findings: In the multivariable context, perinatal mortality was associated with only 3 of the 30 variables: female literacy at the district level, geographical location, and previous neonatal mortality. Maternal morbidity was only associated with geographical location. No facility-level predictors were associated with maternal mortality. Among facilities in the lowest tertile of birth volume (<95 births per month), our models estimated perinatal mortality was 17 (95% CI 11·7–24·8) per 1000 births in the intervention group versus 38 (31·6–44·8) per 1000 in the control group (p<0·0001). Interpretation: Mortality was not directly associated with measured facility-level indicators but was associated with general risk factors. The absence of correlation between expected predictors and patient outcomes and the association between improved outcomes and the intervention in smaller facilities suggest a need for additional measures of quality of care that take into account complexity. Funding: Bill & Melinda Gates Foundation. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X1930261X |
work_keys_str_mv |
AT meganmarxdelaneymsn unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT kateamillerphd unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT laurenbobanskimph unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT shambhavisinghmph unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT vishwajeetkumarmd unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT amikarlageba unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT danielleetullermhs unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT atulagawandeprofmd unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth AT katherineeasemrauphd unpackingthenullaposthocanalysisofaclusterrandomisedcontrolledtrialofthewhosafechildbirthchecklistinuttarpradeshindiabetterbirth |
_version_ |
1724816071479787520 |