Implementing an Intrapartum Package of Interventions to Improve Quality of Care to Reduce the Burden of Preterm Birth in Kenya and Uganda
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Date
2021-01-28
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Implementation science communications
Abstract
Quality of care during the intrapartum and immediate postnatal period for maternal and newborn
health remains a major challenge due to the multiple health system bottlenecks in low-income countries. Reports
of complex interventions that have been effective in reducing maternal and newborn mortality in these settings are
usually limited in description, which inhibits learning and replication. We present a detailed account of the Preterm
Birth Initiative (PTBi) implementation process, experiences and lessons learnt to inform scale-up and replication.
Using the TiDieR framework, we detail how the PTBi implemented an integrated package of
interventions through a pair-matched cluster randomized control trial in 20 health facilities in Migori County, Kenya,
and the Busoga region in east central Uganda from 2016 to 2019. The package aimed to improve quality of care
during the intrapartum and immediate postnatal period with a focus on preterm birth. The package included data
strengthening (DS) and introduction of a modified WHO Safe Childbirth Checklist (mSCC), simulation-based training
and mentoring (PRONTO), and a Quality Improvement (QI) Collaborative.
In 2016, DS and mSCC were introduced to improve existing data processes and increase the quality of
data for measures needed to evaluate study impact. PRONTO and QI interventions were then rolled out
sequentially. While package components were implemented with fidelity, some implementation processes required
contextual adaptation to allow alignment with national priorities and guidelines, and flexibility to optimize uptake.
Lessons learned included the importance of synergy between interventions, the need for local
leadership engagement, and the value of strengthening local systems and resources. Adaptations of individual
elements of the package to suit the local context were important for effective implementation, and the TIDieR
framework provides the guidance needed in detailed description to replicate such a complex intervention in other
settings. Detailed documentation of the implementation process of a complex intervention with mutually
synergistic components can help contextualize trial results and potential for scale-up.
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Citation
Namazzi, G., Achola, K. A., Jenny, A., Santos, N., Butrick, E., Otieno, P., ... & Walker, D. (2021). Implementing an intrapartum package of interventions to improve quality of care to reduce the burden of preterm birth in Kenya and Uganda. Implementation science communications, 2, 1-13.https://doi.org/10.1186/s43058-021-00109-w