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publicado em 19/05/2012 às 11h30:00
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Simple Low-Cost Checklist Improves Practices of Health Workers During Childbirth

Safe Childbirth Checklist Program Aims to Prevent Maternal and Newborn Deaths in Low-Income Countries

 
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Atul Gawande, autor sênior da pesquisa, se prepara para um procedimento cirúrgico no Brigham and Women?s Hospital em Boston
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Atul Gawande, autor sênior da pesquisa, se prepara para um procedimento cirúrgico no Brigham and Women?s Hospital em Boston

A new study from Harvard School of Public Health (HSPH) and the World Health Organization (WHO) found that a simple checklist-based childbirth safety program dramatically improved adherence to essential childbirth care practices at a pilot hospital in south India. Of 29 practices measured, 28 were improved after adoption of the checklist and overall adherence to essential practices was 150% better after the checklist was introduced.

"This is a significant step forward because it provides hope that use of this simple, low-cost tool can help birth attendants better adhere to universally accepted standards in childbirth care," said senior author Atul Gawande. The study appears in the online edition of PLoS ONE.

Nearly 300,000 maternal deaths, 3.1 million newborn deaths, and 1.2 million intrapartum-related stillbirths take place in low-income countries each year; the vast majority are preventable. From 2008 to 2010, HSPH and WHO developed the WHO Safe Childbirth Checklist program to address the major causes of maternal and neonatal mortality. As part of its development, the checklist was field tested for usability in ten countries, mostly in Africa and south Asia.

The researchers conducted the study at a hospital in Karnataka, India.

The 29 items on the checklist address the major causes of maternal deaths (e.g. hemorrhage, infection, obstructed labor, and hypertensive disease), intrapartum-related stillbirths, and neonatal deaths (e.g. complications of premature birth, infection, and birth asphyxia).

Researchers observed the childbirth practices of health care workers during 499 birth events-the period from admission to discharge-prior to introducing the checklist to establish a baseline, and then compared the results with 795 birth events after implementing the checklist.

The results reveal that the number of essential practices performed by the hospital workers increased from an average of 10 of 29 at baseline to 25 of 29 after implementing the checklist. "The checklist program actively prompted health care workers to remember to complete proven practices such as handwashing, infection management, postpartum bleeding assessment, and breastfeeding within an hour after birth," said Dr. Bhala Kodkany, co-investigator.

This study measured the way health workers care for women and newborns during childbirth, but was too small a study to measure the impact on complications or reducing deaths. The researchers are now conducting a large-scale trial in more than 100 hospitals in north India to determine if the checklist program can save the lives of women and newborns.

Source: UNIVERSIDADE DE HARVARD
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Checklist    Low-Cost Checklist    Childbirth    Health Workers During Childbirth    World Health Organization    WHO   
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