Aim of the study
To determine the frequency of the SCC’s use and its association with maternal and neonatal complications at the Yaoundé Gynaeco-Obstetric and Paediatrics Hospital (YGOPH), Cameroon.
Frequency of the SCC’s use and its association with maternal (eclampsia, perineal tears, post-partum haemorrhage) and neonatal (intrapartum foetal death, neonatal asphyxia and neonatal death) outcomes. This was censored at six months after introduction of the checklist at the maternity of the YGOPH, Cameroon.
To evaluate the completion rate of the SCC during the first six months of implementation at the YGOPH, Cameroon.
- Secondary Outcome measure
The completion rate of checklists used, censored at the sixth month of implementation.
We carried out a retrospective study at the Gynaecology and Obstetrics Service of the YGOPH.
Cameroon has a pyramidal health system. The YGOPH is at the top of the pyramid as a tertiary referral hospital specialized in maternal and child care. It has one of the busiest maternities in the country, with over 3 000 deliveries done yearly, amongst which 32% are caesarean births.
The Gynaecology and Obstetrics service has three units: two inpatient units (maternity and inpatient Gynaecology) and one ambulatory Gynaecology unit. This service had 11 Gynaecologists/Obstetricians, one General Practitioner and 56 nursing staff during the study. Vaginal births are conducted at the maternity unit, and it is comprised of 13 admission beds.
Of the nursing staff, 20 are posted to the maternity. They are; 16 Skilled Birth Attendants (SBA), one nurse specialized in reproductive health, one State Registered Nurse (SRN), one Nursing Assistant (NA) and one Certified Nurse (CN). Two of these (a SRN and a SBA) are unit heads at the maternity.
The characteristics of participants
All patients who gave birth at the YGOPH from January to June 2018 with delivery records or clinical notes at the archives of Gynaecology and Obstetrics Service were assessed for eligibility. The clinical note or delivery record is the primary tool used to document care, communicate plans and provide guidance for follow-up treatment and care of a patient.
- Women with incomplete clinical notes (without the delivery route mentioned)
- Delivery records of women who delivered in other facilities and were referred to YGOPH in post-partum
- Women admitted in the maternity for observation or medical reasons (malaria in pregnancy, urinary infection in pregnancy, threatened preterm labour) without ensuing delivery
- Women referred from YGOPH to other institutions to give birth
- Women who gave birth ≤ 22 weeks of gestation
Implementation of the SCC
The management of the Gynaecology and Obstetrics Service introduced the SCC program mid December 2017. An illustrative presentation was done by an Obstetrician, to the Gynaecology and Obstetrics service staff, at the monthly service meeting on using the SCC as part of care delivery. Pilot testing of the SCC later started at the maternity. The nursing staff of the maternity used the SCC, during the pilot phase, from December 2017 to February 2018 under supervision of the two maternity unit heads daily and the chiefs of service weekly.
The official launching of the SCC was done at a seminar organized during the first week of March 2018. During this one day workshop, a refresher course was done on using the checklist and modifications to the safe childbirth checklist were proposed. The modified SCC 29-items, but the criterion for administration of antibiotics in premature rupture of membranes was changed from more than 18 hours to above six hours. However, only one was retained. After this seminar, the maternity unit heads attached the SCC to existing and new delivery records of individual patients. After this seminar, supervision continued daily by the unit heads and weekly by the hospital nursing directors.
Data collection tools
We collected the following information from the patients’ clinical notes:
- Identification: code, age, place of residence
- Past history: obstetric, surgical, medical
- Completion rate of the checklist for each parturient and new-born
- Clinical notes with used checklists and without used checklists
- Obstetric and neonatal complications
This was done using the SPSS version 23·0 software. The association between qualitative variables expressed in frequencies and percentages was investigated using the Chi square or Fisher’s exact test. The student’s T test and Mann Whitney tests were used to investigate the association between quantitative variables. Multivariate analysis was done using binary logistic regression to eliminate potential confounders in the association between the utilization of the checklist and birth outcomes. Results were considered statistically significant at P < 0.05.
Ethics approval and consent to participate
After obtaining administrative authorization and ethical approval from the Institutional Review Board of YGOPH, we began the study. Data collection was done with strict respect of the principle of confidentiality. The rationale of the study was clearly explained to every staff with consent obtained. The identity of every participant was concealed through consecutive numbering.