Adaptación, implementación y evaluación de la efectividad de la "lista de verificación de parto seguro" en cuatro hospitales de México

Abstract

INTRODUCTION Maternal and child health continue to be the most relevant issues when studying population's health. Mexico has not reached the goals set in international agreements in relation to the reduction of maternal mortality, and it is still quite far (current MMR 32) from the goal it must meet by 2030 (MMR 12.6). Despite having a coverage of institutional childbirth above 99%, there is no proportional improvement in the reduction of maternal or neonatal death. There is therefore a clear opportunity for improvement around the care and quality of it received by women and their newborns within the health system. This project arises from the invitation of the World Health Organization to the interested institutions to collaborate with research projects that can validate the SCC in different environments and countries, with the objective of adapt, implement and evaluate the implementation and the effects of the Safe Chilbirth Checklist of the WHO in Mexico, improving the performance of professionals in institutional delivery care. METHODOLOGY Within the framework of a quasi-experimental study, a multi-stage study was designed with the aim of adapt, implement and evaluate the effectiveness of the "safe childbirth checklist" in four hospitals in Mexico. Information was collected and analyzed from the baseline of the study to know the starting point of the practices on which the SCC aims to influence and improve. Subsequently and for 8 months, the implementation of the SCC was carried out in 4 hospitals in the central zone of Mexico and the control in another hospital in which no intervention was carried out. The SCC was to be completed by the health personnel in all deliveries by emergency delivery or caesarean section attended in the intervention hospitals during the study period, in order to improve the adherence to good practices for the management of obstetric complications. RESULTS A Safe childbirth checlist List adapted to the Mexican context was obtained, and a total of 53 indicators were designed (13 of structure, 30 of process and 10 of result). The performance of the implementation of SCC was very unequal between mother and newborns, as well as between intervention hospitals and phases or stages of delivery care. A great variability was found in the use of SCC among hospitals, with a range between 16.9% and 66.2% in mothers and between 63.3% and 83.5% in newborns.The positive perception of the SCC varied greatly among the professional profiles The logistic regression model showed that professionals who considered themselves to be knowledgeable about SCC were more likely to complete it (OR = 10.8, 95% CI 2.6 - 44.5). For the evaluation of the effectiveness of the SCC, 2401 clinical records, 1443 SCC of newborns and 993 SCC of mothers found in them were reviewed. In both the intervention and control hospitals, differences were found between the baseline and post-intervention stage, but without a pattern of improvement in the measured indicators.The only indicators that improved in the intervention hospitals were immediate care of the newborn (baseline = 56.2%, post-implementation = 63.9%) and immediate breastfeeding (baseline = 19.6%; post-implementation = 31.6%). The analysis of differences in differences showed significant improvement in immediate care of the newborn in one of the intervention hospitals (OR = 1.97, 95% CI 1.4 - 2.8.] The improvement in lactation was significant in 3 of the 4 intervention hospitals and in the comparison of the aggregate of the 4 hospitals against control (OR = 1.86, 95% CI 1.3 - 2.7). CONCLUSIONS Mexico currently has a Safe Chilbirth Checklist that is adapted to its regulations and its national clinical practice guidelines. Adaptation to the Mexican context was a fundamental step for its acceptance in health institutions. In this study we have found important differences between observed compliance and the records made by health professionals. The use of SCC is generally associated with an improvement in good practices and some immediate results, but one should be alert to the existence of the risk that the SCC becomes a routine "paperwork", instead of a tool for improve attention. It was not possible to show a strong association between the established factors as possible determinants for the implementation of the SCC and the filling of it.