Pre-post study of an audit and feedback intervention to reduce intrapartum stillbirth in Mombasa, Kenya

摘要 死产对低资源人群的影响不成比例，低收入人群的死胎率要高出10倍。 与高收入国家相比，这两个国家之间的差距更大。造成这种差异的部分原因是医疗保健服务的差距；甚至 配备可提供全面的产科和新生儿急救护理(CEmONC)的设施 未能快速有效地提供护理。三分之一的产中死产(分娩开始后的死产) 可以通过改善分娩和分娩管理以及使用已知的干预措施来预防 有效(如剖腹产)。每一个新生儿行动计划(ENAP)都设定了一个全球目标 到2030年，死胎率为每1000名新生儿中有12名。在海岸省总医院(CPGH)，一家大型CEmONC 在肯尼亚蒙巴萨的一个设施中，产中死产率大大高于这一目标，为每1000人中有21.2人 出生。为了解决这一问题，蒙巴萨县卫生部希望进行审计和反馈 CPGH劳产区质量改进项目。在这项建议中，我们的目标是 确定与CPGH死产相关的因素，以便为该项目的发展提供信息，并评估 这项干预措施在减少产中死产方面的有效性。这项提议的目的是：1)确定 与产中死产相关的因素，可以通过改变提供者的行为来解决；2) 使用中断的时间序列分析进行事前研究，以确定治疗后死产率是否降低 实施审计和反馈干预；以及3)确定增量成本和预算 审计和反馈干预的影响。拟议的研究将采用定量和定性相结合的方法 方法评估过程指标(如剖宫产时间)和产中死产的变化 在审计和反馈干预前后的比率。表明干预在以下方面是多么有效 改变目标提供者的行为和降低死胎率对决定其公共健康至关重要 冲击力。审计和反馈是一种灵活的方法，允许考虑特定于背景的因素，并 地址。如果被发现是有效和低成本的，这种方法可以推广到CEmONC的其他设施 在撒哈拉以南非洲，这是一种降低死胎率的具有成本效益的手段。为了进行这项工作，候选人 将在华盛顿大学接受培训，该大学在实施研究方面处于世界领先地位。她 培训计划将包括实地经验、课程作业、补充培训和实施中的指导。 科学、间断时间序列分析和成本分析。该奖学金还将提供充足的机会 为候选人发表原创研究，在国际会议上展示工作，培养专业人才 网络，并获得撰写赠款的经验。这套技能将使她走上职业生涯的道路 独立调查员。

ABSTRACT Stillbirth disproportionately affects those in low-resource settings, with 10-fold higher stillbirth rates in low-income countries compared to high-income countries. This disparity is due in part to gaps in health care delivery; even facilities that are equipped to provide comprehensive emergency obstetric and newborn care (CEmONC) often fail to deliver care quickly and effectively. A third of intrapartum stillbirths (those occurring after the onset of labor) could be prevented through improved labor and delivery management and use of interventions that are known to be efficacious (e.g. cesarean sections). The Every Newborn Action Plan (ENAP) has set a global target stillbirth rate of 12 per 1000 births by 2030. At Coast Provincial General Hospital (CPGH), a large CEmONC facility in Mombasa, Kenya, the intrapartum stillbirth rate is substantially higher than this target, at 21.2 per 1000 births. To address this problem, the Mombasa County Ministry of Health wishes to conduct an audit and feedback quality improvement project within the Labor and Delivery Ward of CPGH. In this proposal, our objectives are to identify factors associated with stillbirth at CPGH to inform the development of this project, and to evaluate the effectiveness of this intervention in reducing intrapartum stillbirth. The aims of this proposal are: 1) to identify factors associated with intrapartum stillbirth that could be addressed by modifying provider behavior; 2) to conduct a pre-post study using interrupted time series analysis to determine if rates of stillbirth are reduced after implementation of an audit and feedback intervention; and 3) to determine the incremental cost and budget impact of the audit and feedback intervention. The proposed research will use quantitative and qualitative methods to assess change in both process indicators (e.g. time to cesarean section) and intrapartum stillbirth rates before and after the audit and feedback intervention. Demonstrating how effective the intervention is at both changing targeted provider behavior and reducing stillbirth rates is critical to determining its public health impact. Audit and feedback is a flexible approach that allows for context-specific factors to be considered and addressed. If found to be effective and low-cost, this approach could be expanded to other CEmONC facilities in sub-Saharan Africa as a cost-effective means of lowering stillbirth rates. To conduct this work, the candidate will receive training at the University of Washington, which is a world leader in implementation research. Her training plan will include field experience, coursework, supplementary training, and mentorship in implementation science, interrupted time series analysis, and cost analysis. The fellowship will also provide ample opportunities for the candidate to publish original research, present work at international conferences, develop a professional network, and gain experience with grant writing. This set of skills will put her on a path toward a career as an independent investigator.