Stillbirth is a profound tragedy that deeply impacts families and communities. In Ghana, stillbirths account for a significant proportion of perinatal mortalities, highlighting the need for targeted interventions to address this critical public health issue. A recent study conducted in the Volta region revealed a concerning gap between the national stillbirth target and the actual rates observed, with macerated stillbirths being particularly problematic.
The authors of this study set out to address this challenge by implementing a comprehensive quality improvement package aimed at reducing macerated stillbirths by 50% over a two-year period. The intervention, which was implemented in ten facilities, consisted of four key components: strengthening maternity register data, introducing a modified WHO Safe Childbirth Checklist (mSCC), implementing quality improvement collaboratives, and providing PRONTO simulation-based training and team-building exercises.
Maternity Register Data Strengthening
Accurate data collection and utilization are essential for driving meaningful change. The study team worked to improve the quality and completeness of maternity register data, with a particular focus on gestational age assessment and key quality improvement indicators. By reinforcing the importance of accurate data, the researchers laid the foundation for data-driven decision-making and targeted quality improvement efforts.
Modified WHO Safe Childbirth Checklist (mSCC)
The introduction of the mSCC in all 20 study facilities was a crucial component of the intervention. This locally adapted version of the WHO Safe Childbirth Checklist placed additional emphasis on the identification and management of preterm labor, as well as the provision of evidence-based care for newborn infants. By ensuring that essential practices were consistently implemented, the mSCC helped to standardize and improve the quality of intrapartum and immediate newborn care.
Quality Improvement Collaboratives
Quality improvement collaboratives, based on the Institute for Healthcare Improvement (IHI) model, were implemented in the ten intervention facilities. These collaborative learning networks brought together healthcare providers to identify and address gaps in the quality of care, share best practices, and drive continuous improvement. By fostering a culture of quality improvement, the collaboratives empowered frontline staff to take ownership of the change process and implement targeted solutions.
PRONTO Simulation and Team Training
The study team adapted the PRONTO International obstetric and newborn simulation and team training curriculum to focus specifically on the needs of preterm infants. Through hands-on simulation exercises and team-building activities, healthcare providers in the intervention facilities enhanced their skills and communication, leading to improved uptake of evidence-based practices during the intrapartum and immediate newborn period.
The results of this comprehensive quality improvement intervention were remarkable. The study found that the odds of fresh stillbirth and 28-day neonatal mortality among preterm and low-birthweight infants were 34% lower in the intervention facilities compared to the control facilities. Additionally, the intervention was associated with significant reductions in pre-discharge mortality, perinatal mortality, fresh stillbirth, and 28-day neonatal mortality.
These findings underscore the power of a synergistic, evidence-based approach to improving the quality of care for vulnerable newborns. By strengthening data systems, promoting the use of essential practices, building provider competencies, and fostering a culture of continuous improvement, the intervention package was able to drive tangible reductions in macerated stillbirths and neonatal mortality.
Notably, the study’s pragmatic approach, which leveraged existing resources and infrastructure, highlights the scalability and sustainability of this intervention. Unlike advanced neonatal care technologies, the package of interventions implemented in this study can be readily adapted and replicated in similar low-resource settings, making it a promising strategy for addressing the global burden of preterm birth and stillbirth.
As the authors of this study emphasize, addressing the challenge of macerated stillbirth requires a multi-faceted approach that spans the continuum of maternal and newborn care. By targeting the intrapartum and immediate newborn period, the intervention package was able to reinforce the uptake of evidence-based practices known to improve outcomes for preterm and low-birthweight infants.
The success of this study underscores the importance of implementing quality improvement initiatives in a coordinated manner, rather than relying on individual or parallel strategies. The mutually reinforcing nature of the intervention components, from data strengthening to simulation-based training, created a synergistic effect that amplified the impact on reducing macerated stillbirths and improving neonatal survival.
As the global health community continues to prioritize the reduction of stillbirths and neonatal mortality in line with the Sustainable Development Goals, the lessons learned from this study offer valuable insights. By focusing on the quality of care during the critical intrapartum and immediate newborn period, healthcare systems can make significant strides in addressing the devastating burden of macerated stillbirths and improving outcomes for vulnerable infants.
The study’s findings also highlight the importance of adapting interventions to local contexts and engaging key stakeholders, including health facility providers, managers, and community members, in the design and implementation process. This collaborative approach ensures that the interventions are tailored to the specific needs and resources of the target communities, enhancing their effectiveness and sustainability.
In conclusion, the comprehensive quality improvement intervention implemented in this study has demonstrated the potential to significantly reduce macerated stillbirths and improve neonatal survival in low-resource settings. By strengthening data systems, promoting the use of evidence-based practices, building provider competencies, and fostering a culture of continuous improvement, healthcare systems can make tangible progress in addressing this critical public health challenge. As the global community continues to work towards the ambitious goal of ending preventable stillbirths and neonatal deaths, the lessons learned from this study offer a valuable roadmap for driving sustainable change and improving the lives of mothers and their newborns.
