An intervention to improve the quality of emergency care during childbirth in Nigeria

ISRCTN ISRCTN17985403
DOI https://doi.org/10.1186/ISRCTN17985403
Secondary identifying numbers A65869, NCTR91540209
Submission date
03/08/2020
Registration date
14/08/2020
Last edited
17/09/2024
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Pregnancy and Childbirth
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Along with India, Nigeria currently accounts for one-third of the annual maternal deaths in the world. Among several other factors, poor quality of care and the inadequate use of skilled care for pregnant women are the key determinants of the high rate of maternal deaths in Nigeria.
The intervention was designed to improve the quality of care, and patient satisfaction and to reduce deaths of mothers and children during pregnancy and childbirth in Nigeria.

Who can participate?
Pregnant women who access maternal care in participating centers and their health care givers

What does the study involve?
Of the 8 hospitals involved in the study, the intervention was carried out in 4. The intervention activities include structured training in improving maternal outcomes, strategic planning and monitoring, and gathering patient feedback. During the study period data was collected from all 8 hospitals on maternal outcomes to compare between the hospitals that received the intervention and those that did not.

What are the possible benefits and risks of participating?
None

Where is the study run from?
The Women’s Health and Research Centre, Bénin City (Nigeria)

When is the study starting and how long is it expected to run for?
July 2017 to July 2019

Who is funding the study?
World Health Organisation (Switzerland)

Who is the main contact?
Prof. Friday Okonofua, feokonofua@yahoo.co.uk

Contact information

Prof Friday Okonofua
Scientific

KM 11, Lagos-Benin Expressway
Igue-Iheya
Benin City
301000
Nigeria

ORCiD logoORCID ID 0000-0002-8777-2606
Phone +234 8023347828
Email feokonofua@wharc-online.org
Prof Rosemary Ogu
Scientific

University of Port Harcourt
Port Harcourt
500272
Nigeria

ORCiD logoORCID ID 0000-0002-5467-302X
Phone +234 8033129937
Email rosemary.ogu@uniport.edu.ng

Study information

Study designMulti-centre interventional quasi-experimental mixed-methods study
Primary study designInterventional
Secondary study designQuasi-experimental mixed-methods study
Study setting(s)Hospital
Study typeOther
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleIntervention to improve the quality of emergency obstetric care for preventing maternal and perinatal mortality in referral hospitals in Nigeria: a quasi-experimental research study
Study objectives1.There is no significant difference in the policies and patterns of emergency obstetric care and practices between intervention and control health facilities
2. There is no significant difference in the clinical management of the complications that lead to maternal/perinatal deaths between the intervention and control health facilities
3. There is no significant difference in the assessments of the quality of clinical care between intervention and control sites
4. There is no significant difference in case-fatality rates due to leading obstetric complications between intervention and control sites
5. There is no significant difference in the indicators of maternal and newborn outcomes (maternal, stillbirth, and neonatal death ratios) between the intervention and control health facilities
Ethics approval(s)1. Approved 25/06/204, WHO Research Ethics Review Committee (20 Avenue Appia-CH-1211 Geneva 27, Switzerland; no telephone number provided; ercsec@who.int), ref: A65869.
2. Approved 16/07/2014, National Health Research Ethics Committee (NHREC) of Nigeria (Federal Ministry of Health, Federal Secretariat, Abuja, Nigeria; +234-9-523-8367; info@nhrec.net), ref: NHREC/01/01/2007 – renewed in 2015, ref: NHREC 01/01/20047-12/12/2015b
Health condition(s) or problem(s) studiedEmergency obstetric care
InterventionAll the women who presented for antenatal, delivery and postnatal care within the period were eligible for inclusion in the study. Recruitment and informed consent were obtained at the time the women registered in the hospitals for antenatal care, or during admission for management of complications, or at the time of delivery. Informed consent was obtained from those presenting with pregnancy related complications when they have been clinically stabilized. For women presenting at the hospital for the first time in labour, consent is obtained after they delivered their babies. The monitoring/evaluation officer collects and enters the data into the computer system daily. Sources of data collection were hospital records, clinical case records, maternal/perinatal deaths clinical audit records, maternal/perinatal death reviews, client flow analysis, focus group discussion, in-depth interview, and exit interviews. Total duration of observation is the total time the woman spends at the facility.

Six public secondary care hospitals and two public tertiary care hospitals in both north and south of Nigeria were selected randomly for the formative phase. Thereafter the intervention was carried out in four of the initial eight hospitals, with two hospitals as intervention and two as control sites. At baseline, we assessed the providers’ and facilities’ readiness to provide care, patients' satisfaction and experience while accessing obstetric care, using a mixed-method which included a questionnaire on knowledge and management of obstetric complications, site inventory assessment, client flow analysis, focus group discussion and in-depth interviews.
The intervention activities which were developed based on the results in the formative research include
1. Development of a strategic plan for preventing maternal and perinatal deaths
2. Staff Training/Capacity building for healthcare providers in the facilities
3. Establishing a maternal and perinatal death surveillance and response system (MPDSR) in the health facilities
4. Development of protocols, guidelines, algorithm and reminders for clinical Emergency Obstetric Care EmOC
5. Advocacy activities for increased funding and resource mobilization
6. Computerized appointment scheduling system to reducing delays in service delivery
7. Patients education and feedback- Involving men in maternal and child health care through monthly health talk
Intervention typeMixed
Primary outcome measureMeasured at baseline, monthly during the intervention, and at endline using patient records:
1. Number of women attending antenatal, delivery and post-natal clinics
2. Women with moderate to severe PPH, eclampsia, and obstructed labour
3. Number of cases with PPH, eclampsia and obstructed labour where internationally accepted protocols are adhered to or breeched
4. Number of clinically managed cases of PPH, eclampsia and obstructed that died
5. Number of maternal deaths
6. Number of stillbirths and early neonatal deaths occurring in the hospitals
Secondary outcome measuresClient perception of quality and satisfaction with care measured using client flow analysis (patient records) at baseline, monthly during the intervention, and at endline and also by an exit interview questionnaire
Overall study start date01/07/2017
Completion date30/07/2019

Eligibility

Participant type(s)Mixed
Age groupAdult
SexBoth
Target number of participants18,000 patient records reviewed and 2,400 interviewed
Total final enrolment20439
Key inclusion criteria1. Pregnant women that present during the intervention period
2. All the healthcare givers in the obstetric units
Key exclusion criteriaDoes not meet inclusion criteria
Date of first enrolment01/10/2017
Date of final enrolment30/06/2019

Locations

Countries of recruitment

  • Nigeria

Study participating centres

Central Hospital Benin City
Benin City
301000
Nigeria
Central Hospital Warri
Warri
-
Nigeria
General Hospital Minna
Minna
-
Nigeria
General Hospital Suleja
Suleja
-
Nigeria

Sponsor information

World Health Organization
Research council

20 Avenue Appia-CH-1211
Geneva
CH1211
Switzerland

Phone +41 22 791 3791
Email ercsec@who.int
Website https://www.WHO.INT.RPC/Research_Ethics
ROR logo "ROR" https://ror.org/01f80g185

Funders

Funder type

Research organisation

World Health Organization
Private sector organisation / International organizations
Alternative name(s)
منظمة الصحة العالمية, 世界卫生组织, Всемирная организация здравоохранения, Organisation mondiale de la Santé, Organización Mundial de la Salud, WHO, 世卫组织, ВОЗ, OMS
Location
Switzerland

Results and Publications

Intention to publish date30/10/2020
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryStored in repository
Publication and dissemination planData repository
Publication in high impact journals
Policy document
IPD sharing planThe datasets generated during and/or analysed during the current study will be stored in a publically available repository.
The datasets generated during the formative phase of this study is stored on Zenodo (http://doi.org/10.5281/zenodo.161549). Users are expected to request for access from the Principal Investigator, Professor Friday Okonofua Email feokonofua@yahoo.co.uk. The intervention datasets will also be stored on Zenodo and will be available on request from the principal Investigator. The qualitative data are outputs generated from a computer-assisted qualitative data analysis software, Atlas.ti version 6.25, whereas the quantitative data are all stored in SPSS format. There are no legal issues, and no consent to share is required from the participants.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article Effects on rates of primary postpartum haemorrhage (PPH) 01/04/2022 17/08/2022 Yes No
Results article Results of exit interviews with mothers 26/08/2023 29/08/2023 Yes No
Results article improving six quality indicators 04/11/2020 17/09/2024 Yes No

Editorial Notes

17/09/2024: Publication reference added.
29/08/2023: The following changes have been made:
1. Publication reference added.
2. The NCTR number has been added from the reference
17/08/2022: Publication reference added.
14/08/2020: Internal review.
12/08/2020: Trial’s existence confirmed by the World Health Organization.