Reducing fresh full term intrapartum stillbirths through leadership and accountability in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe

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Abstract

Background

Stillbirths are distressing to the parents and healthcare workers. Globally large numbers of babies are stillborn. A number of strategies have been implemented to try and reduce stillbirths worldwide. The objective of this study was to assess the impact of leadership and accountability changes on reducing full term intrapartum stillbirths.

Methods

Leadership and accountability changes were implemented in January 2016. This retrospective cohort study was carried out to assess the impact of the changes on fresh full term intrapartum stillbirths covering the period 6 months prior to the implementation date and 12 months after the implementation date. The changes included leadership and accountability. Fresh full term stillbirths (>37 weeks gestation) occurring during the intrapartum stage of labour were analysed to see if there would be any reduction in numbers after the measures were put in place.

Results

There was a reduction in the number of fresh full term intrapartum stillbirths after the introduction of the measures. There was a statistical difference before and after implementation of the changes, 50% vs 0%, P = 0.025. There was a reduction in the time it took to perform an emergency caesarean section from a mean of 30 to 15 min by the end of the study, a 50% reduction.

Conclusions

Clear and consistent clinical leadership and accountability can help in the global attempts to reduce stillbirth figures. Simple measures can contribute to improving perinatal outcomes.

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Most cited references 9

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Stillbirths: ending preventable deaths by 2030.

Luc de Bernis, Mary V. Kinney, William Stones … (2016)

Efforts to achieve the new worldwide goals for maternal and child survival will also prevent stillbirth and improve health and developmental outcomes. However, the number of annual stillbirths remains unchanged since 2011 and is unacceptably high: an estimated 2.6 million in 2015. Failure to consistently include global targets or indicators for stillbirth in post-2015 initiatives shows that stillbirths are hidden in the worldwide agenda. This Series paper summarises findings from previous papers in this Series, presents new analyses, and proposes specific criteria for successful integration of stillbirths into post-2015 initiatives for women's and children's health. Five priority areas to change the stillbirth trend include intentional leadership; increased voice, especially of women; implementation of integrated interventions with commensurate investment; indicators to measure effect of interventions and especially to monitor progress; and investigation into crucial knowledge gaps. The post-2015 agenda represents opportunities for all stakeholders to act together to end all preventable deaths, including stillbirths.

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Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review.

M Aminu, R Unkels, M Mdegela … (2014)

Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors.

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Reducing intrapartum-related neonatal deaths in low- and middle-income countries-what works?

Stephen Wall, Anne C C Lee, Waldemar F Carlo … (2010)

Each year, 814,000 neonatal deaths and 1.02 million stillbirths result from intrapartum-related causes, such as intrauterine hypoxia. Almost all of these deaths are in low- and middle-income countries, where women frequently lack access to quality perinatal care and may delay care-seeking. Approximately 60 million annual births occur outside of health facilities, and most of these childbirths are without a skilled birth attendant. Conditions that increase the risk of intrauterine hypoxia--such as pre-eclampsia/eclampsia, obstructed labor, and low birth weight--are often more prevalent in low resource settings. Intrapartum-related neonatal deaths can be averted by a range of interventions that prevent intrapartum complications (eg, prevention and management of pre-eclampsia), detect and manage intrapartum problems (eg, monitoring progress of labor with access to emergency obstetrical care), and identify and assist the nonbreathing newborn (eg, stimulation and bag-mask ventilation). Simple, affordable, and effective approaches are available for low-resource settings, including community-based strategies to increase skilled birth attendance, partograph use by frontline health workers linked to emergency obstetrical care services, task shifting to increase access to Cesarean delivery, and simplified neonatal resuscitation training (Helping Babies Breathe(SM)). Coverage of effective interventions is low, however, and many opportunities are missed to provide quality care within existing health systems. In sub-Saharan Africa, recent health services assessments found only 15% of hospitals equipped to provide basic neonatal resuscitation. In the short term, intrapartum-related neonatal deaths can be substantially reduced by improving the quality of services for all childbirths that occur in health facilities, identifying and addressing the missed opportunities to provide effective interventions to those who seek facility-based care. For example, providing neonatal resuscitation for 90% of deliveries currently taking place in health facilities would save more than 93,000 newborn lives each year. Longer-term strategies must address the gaps in coverage of institutional delivery, skilled birth attendance, and quality by strengthening health systems, increasing demand for care, and improving community-based services. Both short- and long-term strategies to reduce intrapartum-related mortality should focus on reducing inequities in coverage and quality of obstetrical and perinatal care. Copyright © 2010 Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Solwayo Ngwenya: +263 9 214965 , drsolngwe@yahoo.co.uk

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central (London )

ISSN (Electronic): 1756-0500

Publication date (Electronic): 6 July 2017

Publication date PMC-release: 6 July 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 246

Affiliations

[1 ]ISNI 0000 0004 0387 6286, GRID grid.416209.8, Department of Obstetrics & Gynaecology, , Mpilo Central Hospital, ; Vera Road, Mzilikazi, P.O. Box 2096, Bulawayo, Matabeleland Zimbabwe

[2 ]Department of Obstetrics & Gynaecology, Royal Women’s Clinic, 52A Cecil Avenue, Hillside, Bulawayo, Matabeleland Zimbabwe

[3 ]GRID grid.440812.b, , National University of Science and Technology, Medical School, ; Bulawayo, Matabeleland Zimbabwe

Article

Publisher ID: 2567

DOI: 10.1186/s13104-017-2567-z

PMC ID: 5501452

PubMed ID: 28683767

SO-VID: 63e81dc3-b231-4187-ae8e-7f8926098e7c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 August 2016

Date accepted : 26 June 2017

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ScienceOpen disciplines: Medicine

Keywords: fresh full term intrapartum stillbirths,leadership,accountability,perinatal outcomes,low-resource settings,mpilo central hospital

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ScienceOpen disciplines: Medicine

Keywords: fresh full term intrapartum stillbirths, leadership, accountability, perinatal outcomes, low-resource settings, mpilo central hospital

Reducing fresh full term intrapartum stillbirths through leadership and accountability in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe

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Abstract

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Methods

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Conclusions

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Most cited references 9

Stillbirths: ending preventable deaths by 2030.

Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review.

Reducing intrapartum-related neonatal deaths in low- and middle-income countries-what works?

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