When Fatima* was seven months pregnant, there was despair instead of joy among family and doctors surrounding her. Her baby was expected to be born prematurely and was thus at risk of respiratory disorders, underdevelopment, and even death. Luckily for Fatima, she was being treated at Sangareddy District Hospital in Telangana, India. There, a Quality Improvement Team had been set up through the Safe Care, Saving Lives program. The team administered Fatima two doses of antenatal corticosteroid. She went on to deliver a healthy baby.
Saving babies born prematurely is a challenge for healthcare providers in developed and developing countries alike. But India seems to have the unenviable record of having the highest number of preterm deliveries, with approximately ten percent of those babies not surviving. At twenty five per thousand live births, Telangana state in India has a higher neonatal mortality rate than any other in that region. Approximately fifteen thousand newborn deaths are reported in Telangana each year.
A simple solution to help reduce deaths among babies born prematurely is to administer antenatal corticosteroids to pregnant women at risk of preterm birth. Corticosteroid is one of the most important antenatal therapies available to improve newborn outcomes, reducing respiratory distress syndrome, intraventricular haemorrhage, and necrotizing enterocolitis. Evidence suggest corticosteroid administration rates can and should be optimized to reach more than ninety percent of eligible pregnant women. The current coverage in Telangana is a dismal 2.8 percent. The real challenge for the team is to increase coverage of the use of antenatal corticosteroids and ensure through regular monitoring and evaluation that women who receive corticosteroids give birth to healthy babies.
At the district hospital in Sangareddy, Telangana, the Quality Improvement Team helped discover challenges with the accurate identification of women in need of corticosteroid therapy. Throughout 2015, for example, the hospital had issues with properly documenting women at risk and keeping track of their record. Inaccuracies in recording the correct gestational age of the mothers were particularly concerning, as that is the most critical component when it comes to deciding when to administer the corticosteroids. For mothers who received the treatment, there was poor tracking of their obstetric history, true and false labor pains, stage of labor, dosage, and time of administration.
The Quality Improvement Team at Sangareddy District Hospital found simple solutions to address these challenges. They started maintaining separate registers, recording data sequentially and identifying eligible pregnant women. They ensured that there were correct estimates of gestational age and that the dosing for corticosteroids was scientifically administered to ensure that there was a lead time of two to four hours at least before the woman went into labour. They also started tracking the mothers who were administered ANCS in the hospital and also after getting discharged from the hospital.
In 2015, corticosteroids were administered on average to fourteen pregnant women every month. After the Quality Improvement team introduced their changes, the average number of women receiving corticosteroids increased by nearly sixty percent. More importantly, the number of preterm babies experiencing respiratory distress decreased by fifty percent, from nineteen babies per month to just twelve.
Read more about the dedicated staff implementing these quality improvement changes in Sangareddy by clicking here.
About Safe Care, Saving Lives Program
As part of ACCESS Health International’s Safe Care, Saving Lives program, hospital staff and administrators are addressing some of the causes of neonatal deaths in the region. The program, funded by the Children’s Investment Fund Foundation, focuses on improving the quality of newborn and maternal care through a quality improvement program that generates simple, cost effective solutions.
The Sangareddy District Hospital Quality Improvement Team is comprised of obstetricians Dr. K Raju Goud and Dr. Gayathri, as well as senior staff nurses Ms. B. Vinod Kumari and Ms. Jhansi.
*Name changed to respect privacy.