Widespread non‐adherence to evidence‐based maternity care guidelines: a population‐based cluster randomised household survey. (22nd August 2014)

• Record Type: Journal Article
• Authors: Nagpal, J; Sachdeva, A; Sengupta Dhar, R; Bhargava, VL; Bhartia, A
• Is Part Of: BJOG. Volume 122:Number 2(2015:Feb.)
• Page Start: 238
• Page End: 247
• Publication Date: 2014-08-22
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.13054
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo13054-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo13054-sec-0001" sec-type="section"> <title>Objective</title> <p>To assess the quality of maternity care in an Indian metropolitan city.</p> </sec> <sec id="bjo13054-sec-0002" sec-type="section"> <title>Study design</title> <p>Three‐stage cluster randomised cross‐sectional survey.</p> </sec> <sec id="bjo13054-sec-0003" sec-type="section"> <title>Setting</title> <p>Sixty selected colonies of Delhi.</p> </sec> <sec id="bjo13054-sec-0004" sec-type="section"> <title>Population</title> <p>One thousand eight hundred and one subjects (of 2286 eligible) were enrolled from 118 446 houses. Women who had delivered a live viable birth in the past 6 months were selected for the study.</p> </sec> <sec id="bjo13054-sec-0005" sec-type="section"> <title>Methods</title> <p>In stage 1, 20 wards (of 150) were selected using a probability‐proportionate‐to‐size systematic method. In stage 2, one colony from each income stratum (high, middle and low) was selected from each ward by simple random sampling. In stage 3, a house‐to‐house survey was conducted to recruit 30 women for administering a peer‐reviewed and pilot‐trialled questionnaire.</p> </sec> <sec id="bjo13054-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Caesarean section rate, induction rate and episiotomy rate.</p> </sec> <sec id="bjo13054-sec-0007" sec-type="section"> <title>Results</title> <p>National health targets such as iron supplementation advice (>96%), tetanus vaccination (>81%), and ≥3 antenatal visits (>90%) were largely achieved across health care facilities but not in home deliveries. Interventions were lower in public than private hospitals: caesarean section [23.7% (20.2–27.7) versus 53.8% (49.3–58.3)], induction [20.6% (17.5–24.25) versus 30.8% (26.8–33.2)] and episiotomy [57.8% (52.3–63.1) versus 79.4% (71.0–85.9)]. Private hospitals achieved better labour support rates [1.1% (0.5–2.2) versus 14.6% (8.5–24.1)] and pain relief [0.9% (0.4–2.0) versus 9.9 (6.5–14.8)]. Pubic hair shaving [16.2% (11.5–22.5) versus 36.4% (29.9–43.4)], enema [20.2% (15.5–26.0) versus 57.3% (49.5–64.8)], and IV fluids during labour [44.0% (36.2–52.2) versus 38.7% (29.3–49.1)] were widely prevalent in public and private hospitals.</p> </sec> <sec id="bjo13054-sec-0008" sec-type="section"> <title>Conclusion</title> <p>Present practices fall short of evidence‐based guidelines, with relative overuse of interventions in private hospitals and deficiency of patient‐centred practices such as labour support in public hospitals.</p> </sec> </abstract>