Speaker
Description
Background: The partograph and safe childbirth checklist (SCC) are quality improvement (QI) tools in intrapartum care that have long been recommended for use. Poor-quality intrapartum care remains a significant barrier to improving health outcomes in countries like Ethiopia, largely due to total non-use or poor adherence to these QI tools. eHealth-based interventions present promising strategies to enhance healthcare quality. We conducted implementation research to examine the effect of ADHERE, an innovative eHealth system with a clinical decision support element, on adherence to QI tools during intrapartum care in health facilities in Ethiopia.
Methods: A quasi-experimental study was conducted in 3 hospitals and 6 health centers (5 intervention and 4 control) in Ethiopia, guided by the Implementation Research Logic Model. Data were collected from labor and delivery charts by trained data collectors. A total of 2,190 charts (1,076 baseline and 1,114 end-line) were included in the analysis. Difference-in-difference (DiD) analysis was used to estimate the effect of the intervention. The partograph adherence score and SCC completion rates were compared between the two arms. Statistically significant differences were determined using a p-value < 0.05 cutoff.
Results: Baseline mean partograph scores in the control and intervention arms were 4.11 and 4.23, respectively. Baseline SCC adherence rates at admission, before-birth, after-birth, and discharge were 25.8%, 24.9%, 24.9%, and 24.3% in the control arm, respectively, and 49.6%, 47.8%, 45.9%, and 45.5% in the intervention arm, respectively. The ADHERE intervention increased partograph adherence score by 4.27 units (DiD = 4.27, 95%CI [1.80, 5.09]). The ADHERE intervention increased SCC adherence by 9.3 percentage-points (DiD = 0.093, 95%CI [0.036, 0.151]) at admission, 22.3 percentage-points (DiD = 0.223, 95%CI [0.121, 0.325]) before-birth, and 15.2 percentage-points (DiD = 0.152, 95%CI [0.072, 0.231]) after-birth. Conversely, the ADHERE intervention did not significantly change SCC adherence at discharge (DiD = -0.025, 95%CI [-0.071, 0.021]).
Conclusion: The ADHERE intervention significantly improved adherence to partograph and SCC at admission, before-birth, and immediately after-birth during intrapartum care. Therefore, ADHERE-assisted implementation of QI tools can potentially prevent adverse birth outcomes related to low-quality intrapartum care and could be considered for scale up across health facilities in Ethiopia.
