Principled Subpopulation Analysis of the BetterBirth Study and the Impact of WHO's Safe Childbirth Checklist Intervention

Abstract

The World Health Organization (WHO) developed the Safe Childbirth Checklist as an intervention to improve care and outcomes in maternal and newborn health. The original study reported that the intervention did not significantly improve the outcomes. In this work, we employ a principled data-driven analysis to identify subpopulations with divergent characteristics: 1) vulnerable subgroups with the highest risk of neonatal deaths and 2) subgroups in the intervention arm that benefited from the Checklist intervention with significantly reduced risks of deaths and complications. Results demonstrate that low birth weight represented the most vulnerable group, whereas mother-baby dyads described by normal gestational age at birth, known parity, and unknown number of abortions was found to benefit from the Checklist intervention (OR : 0.70, 95%CI : 0.62-0.79, p < 0.001). Generally, the flexibility of our approach helps to answer subgroup-based queries in the broader global health domain, which also provides further insights to domain experts.

Figure 1:

Overview of the approach used to discover the anomalous subgroups of the BetterBirth study with respect to outcome vulnerability and intervention impact.

Figure 2:

Results from heterogeneous treatment effect analysis, which are identified across three outcomes: (a) Neonatal death, (b) Primary and (c) Secondary. The reduced outcome rate of the anomalous group in the intervention reflects the impact of WHO’s Checklist intervention for these identified subpopulations, compared to the corresponding group in the control arm with similar covariate profile.