Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)—a stepped wedge cluster randomized controlled trial in public hospitals

摘要: Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- middle-income countries. Despite the accelerated increase proportion deliveries health facilities these settings, stillborn mortality rates have not reduced proportionately. Poor quality care is attributed to two-thirds deaths. Improving during intrapartum period needs investments evidence-based interventions. We aim evaluate improvement package—Scaling Up Safer Bundle Through Quality Improvement Nepal (SUSTAIN)—on public hospitals Nepal. will conduct a stepped wedge cluster randomized controlled trial eight each having least 3000 year. hospital represent an intervention transition 2 months each. With level significance 95%, statistical power 90% intra-cluster correlation 0.00015, study 19 months should detect at 15% change mortality. training, mentoring, systematic feedback, continuous cycle be instituted based on bottleneck analyses hospital. All concerned workers trained standard basic resuscitation essential newborn care. Portable fetal heart monitors (Moyo®) rate (Neobeat®) introduced identify distress labor improve resuscitation. Independent research teams collect data inputs, processes, outcomes by reviewing records carrying out observations interviews. The dose-response effect evaluated through process evaluations. global momentum care, better understanding QI package within facility context important. proposed experiences from similar previous scale-up carried evaluation provide evidence technology for implementation scale up settings. ISRCTN16741720 . Registered 2 March 2019.