A Skills and Drills Intervention for Emergency Obstetrics and Neonatal Care at First Referral Units of North Karnataka

A Skills and Drills Intervention for Emergency Obstetrics and Neonatal Care at First Referral Units of North Karnataka

Skills and Drills Intervention for Improving Emergency Obstetric and Neonatal Care in Select First Referral Units in Northern Karnataka

St. John's Research Institute, Maternal Health Task Force, Bill and Melinda Gates Foundation, Karnataka Health Promotion Trust

To evaluate the effectiveness of a First Referral Unit (FRU) Emergency Obstetric and Newborn Care (EmONC) skills and drills intervention, to estimate the appropriateness and effectiveness of referrals in intervention arm compared to control arm and to calculate the incremental cost and cost effectiveness of EmONC skills and drills intervention.

The aim of this intervention is to improve the quality of care for institutional births with a special focus on improving the quality of Emergency Obstetric and Newborn Care (EmONC). This intervention will focus on improving the skills and practices of providers and through the improvement of referral networks, ensure timely and appropriate management of complications. The specific objectives include: Evaluate the effectiveness of an FRU-level Basic and EmONC Skills and Drills intervention combined with the existing primary health centre (PHC) based nurse mentoring intervention in improving appropriate diagnosis and management of obstetric and perinatal complications. Assess the additional benefit of the EmONC Skills and drills intervention at FRUs in terms of improvement of obstetric and perinatal outcomes compared to the PHC-level intervention alone. Estimate the appropriateness and effectiveness of referrals in intervention facilities compared to controls. Calculate the incremental cost and cost-effectiveness of the EmONC skills and drills intervention

Obstetric and Perinatal Complications, Postpartum Hemorrhage, Preeclampsia/Eclampsia, Obstructed/Prolonged Labor, Sepsis, Birth Asphyxia

provider skill and self-efficacy, Appropriate and timely referral for obstetric emergencies, Intervention feasibility and acceptability

A Quasi-experimental intervention/control trial will be implemented to assess the impact of the following interventions on the outcome measures in a cluster of 4 intervention sites relative to a matched cluster of 4 control sites: Refresher/simulation training to improve provider skills/knowledge Implementation of Emergency Obstetric Drills Revised Case sheets(for data collection and therefore part of both control and intervention sites), Mentoring and Supportive supervision, and Referral Strengthening

Emergency obstetric drills to practice timely and appropriate management of postpartum hemorrhage and preeclampsia/eclampsia

Revised case sheets will be introduced to capture the timing and appropriate medical treatment of women in labor and newborns

Appropriate and timely management of postpartum hemorrhage (PPH), Preeclampsia, Obstructed or prolonged labor, Sepsis and birth asphyxia

We will evaluate barriers and facilitators of implementing these intervention packages, as well as costing them.

Knowledge and skills competency of health care personnel on the management of obstetric and neonatal complications

Inclusion Criteria: All women age who are referred or admitted directly to the first referral unit for a delivery or with a complication Staff working in the First Referral Units Exclusion Criteria: no specific exclusion criteria