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Randomized Controlled Trial
. 2022 Dec 29:12:04073.
doi: 10.7189/jogh.12.04073.

Effect of a quality improvement intervention for management of preterm births on outcomes of all births in Kenya and Uganda: A secondary analysis from a facility-based cluster randomized trial

Rakesh Ghosh #  1 , Phelgona Otieno #  2 , Elizabeth Butrick  1 , Nicole Santos  1 , Peter Waiswa  3   4 , Dilys Walker  1   5 ; Preterm Birth Initiative Kenya and Uganda Implementation Research Collaborative
Affiliations
Randomized Controlled Trial

Effect of a quality improvement intervention for management of preterm births on outcomes of all births in Kenya and Uganda: A secondary analysis from a facility-based cluster randomized trial

Rakesh Ghosh et al. J Glob Health. .

Abstract

Background: A large proportion of early neonatal deaths occur at the time or on the first day of birth. The Preterm Birth Initiative East Africa (PTBi EA) set out to decrease mortality among preterm births through improving quality of facility-based intrapartum care. The PTBi EA cluster randomized trial's primary analysis showed the package reduced intrapartum stillbirth and neonatal death among preterm infants. This secondary analysis examines the impact of the PTBi intervention package on stillbirth and predischarge newborn deaths combined, among all births in 20 participating facilities in Kenya and Uganda.

Methods: Eligible facilities were pair-matched and randomly assigned (1:1) into either the intervention or the control group. All facilities received support for data strengthening and a modified World Health Organization (WHO) Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. We abstracted data from maternity registers.

Results: Of the total 29 442 births that were included, Kenya had 8468 and 6465 births and Uganda had 8719 and 5790 births, in the control and intervention arms, respectively. There were 935 stillbirths and predischarge newborn deaths in the control arm and 439 in the intervention arm. The adjusted odds ratio (aOR) for the effect of the intervention on the combined outcome, among all births, was 0.96 (95% confidence interval (CI) = 0.69-1.32), which was different by country: Kenya - 1.12 (95% CI = 0.72-1.73); Uganda - 0.65 (95% CI = 0.44-0.98); Pinteraction = 0.025. These trends were similar after excluding the PTBi primary cohort.

Conclusions: The intervention package improved survival among all births in Uganda but not in Kenya. These results suggest the importance of context and facility differences that were observed between the two countries.

Registration: This trial is registered with ClinicalTrials.gov, NCT03112018.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare that Dilys Walker is cofounder of PRONTO International. All other authors disclose no relevant interests.

Figures

Figure 1
Figure 1
The Preterm Birth Initiative (PTBi) study trial profile for all births. The included and the excluded sample were compared to examine selection bias.
Figure 2
Figure 2
Temporal trends of the combined percentage of stillbirths and predischarge newborn mortality among all births, by the Preterm Birth Initiative (PTBi) study trial arms in Kenya and Uganda, reported for each quarter. In Kenya, we truncated in June 2018 to show comparable time points for both countries in this graph.
See this image and copyright information in PMC

References

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