Impact of the Safe Childbirth Checklist in Luapula Province of Zambia Province of Zambia

Study Overview
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Brief Summary
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This study would like to determine if the introduction of the Safe Childbirth Checklist and associated mentorship can improve the adherence of skilled birth attendants (SBAs) to the essential practices of childbirth delivery.

Detailed Description
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This study will use a pre-post study design to measure health worker adherence to the essential practices for delivery care outlined in the Safe Childbirth Checklist (SCC). The intervention, including the introduction of the SCC and mentorship visits to support uptake, will be tested in four purposively selected health facilities in Nchelenge District, Luapula Province of Zambia. Since the essential delivery care practices outlined in the SCC are evidence-based practices broadly accepted to support positive clinical outcomes for mothers and infants, this evaluation will focus on adherence to the checklist rather than on patient outcomes. Data will be collected through observations of skilled birth attendants assisting with childbirth delivery before the start of the intervention and again at 3 months and 6 months post-intervention. A health worker questionnaire will be administered at the time that the SCC is introduced and six months later to gather their perspectives on incorporating the SCC into clinical practice in Zambia.

Official Title
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Impact of the Safe Childbirth Checklist on Health Worker Childbirth Practices in Luapula Province of Zambia

Conditions
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Maternal Death, Newborn Death

Intervention / Treatment
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* Behavioral: Introduction of the Safe Childbirth Checklist


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For facility observations, all consecutive deliveries will be observed. If a pregnant woman or health worker declines to participate in the consent process, no observations will be recorded. Exclusion Criteria: -
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Nchelenge Facilities<br>Purposively selected health facilities based on criteria including: high demand for services, perceived need for support for quality improvement, and presence of a SBA to mentor. | Behavioral: Introduction of the Safe Childbirth Checklist<br>* Adaptation of the SCC tool to Zambia: In order to produce a tool that is fully relevant to the Zambian context, a team of clinical experts from the MOH adapted the language of the SCC. Training of trainers on the SCC by international experts: Ariadne Labs has designed a training-of-trainers (TOT) for coach training to support quality improvement initiatives, including the implementation of the WHO SCC. Members of the district mentorship team for Nchelenge District will receive this type of TOT training. Following the TOT session, the district mentorship team will conduct facility-level training for health workers on using the SCC. Within target facilities, all public sector health workers will be invited to participate in the training. Mentorship and support to facility-level health workers on using the SCC: The district mentorship team will carry out coaching and support visits to health facilities following the initial SCC training.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the average proportion of observed, SCC tasks completed per birth from selected task list | Numerator: Count of SCC tasks observed and completed for each delivery, according to the specifications for data collection outlined in the data collection procedures Denominator: Count of potential SCC items observed | Through study completion, an average of 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Characteristics of health workers participating in facility-level SCC training | Questionnaire to understand Health worker cadre and training | Baseline | 
| Feedback of health workers participating in facility-level SCC training | Proportion of health workers agreeing with statements on the clarity of the training and their confidence in using the SCC after the training | Baseline | 
| Feedback of health workers in participating facilities on SCC implementation | Questionnaire to understand Health worker cadre and training | 6 months | 
| Feedback of health workers in participating facilities on SCC implementation | Proportion of health workers agreeing with on ease of using the SCC and challenges faced in implementation | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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childbirth, delivery