Effect of meso-and micro-level quality improvement interventions to improve intrapartum care and birth outcome in Nepal- stepped wedge cluster randomized trial.

@article{gurung2026effect,
  title = {{Effect of meso-and micro-level quality improvement interventions to improve intrapartum care and birth outcome in Nepal- stepped wedge cluster randomized trial.}},
  author = {Rejina Gurung and Omkar Basnet and Prajwal Paudel and Lea Kreyenbaum and Pratiksha Bhattarai and Abhishek Gurung and Honey Malla and Avinash K Sunny and Srijana Sharma and Anna Axelin and Mats Målqvist and Luong Nguyen Thanh and Ashish Kc},
  journal = {AJOG global reports},
  year = {2026},
  month = sep,
  doi = {10.1016/j.xagr.2026.100697},
  url = {https://europepmc.org/article/MED/42898165},
  note = {CC BY},
}

TY  - JOUR
TI  - Effect of meso-and micro-level quality improvement interventions to improve intrapartum care and birth outcome in Nepal- stepped wedge cluster randomized trial.
AU  - Rejina Gurung
AU  - Omkar Basnet
AU  - Prajwal Paudel
AU  - Lea Kreyenbaum
AU  - Pratiksha Bhattarai
AU  - Abhishek Gurung
AU  - Honey Malla
AU  - Avinash K Sunny
AU  - Srijana Sharma
AU  - Anna Axelin
AU  - Mats Målqvist
AU  - Luong Nguyen Thanh
AU  - Ashish Kc
PY  - 2026
DA  - 2026/09/16
JO  - AJOG global reports
DO  - 10.1016/j.xagr.2026.100697
UR  - https://europepmc.org/article/MED/42898165
AB  - Background  High-quality intrapartum care benefits from implementation of quality improvement (QI) interventions. However, scale-up of meso- and micro-level QI interventions to improve health facility performance have shown mixed results in Nepal.Objective  This study aims to evaluate the effect of such interventions to intrapartum care and intrapartum mortality (intrapartum stillbirth and first day neonatal death) in public health facilities of Nepal.Study design  A stepped-wedge cluster randomized design was applied to implement the SUSTAIN package, comprising meso- and micro-level QI interventions in 8 hospitals across all provinces of Nepal over a 21-month period. Each hospital had a 2-month window to introduce QI interventions in their governance and clinical processes. Women with gestational age ≥22 weeks were included with research teams established in each hospital to monitor mortality and health workers' performance. For each outcome, hospital-specific incidence rate ratios (IRRs) were estimated by comparing event rates in the intervention period with those in the control period.Results  The study enrolled, 55,325 and 53,578 women were enrolled in the control and intervention periods, respectively. The SUSTAIN package resulted in a statistically non-significant reduction (16%) in intrapartum mortality at the hospital level (IRR 0.84 (95% CI: 0.66, 1.08)), while at the individual level there was also statistically non-significant lower odd (37%) of mortality (aOR: 0.63 (0.38, 1.04), P<.0001)). Improvement in intrapartum care were consistent in most of care indicators with adherence to hand-washing increased by 2.36 fold (IRR 2.36 (95% CI: 1.03, 5.39)), fetal heart-rate monitoring increased by 1.55 fold (IRR 1.55 (95% CI: 1.10, 2.17)), delayed cord clamping increased non-significantly by1.14 fold (IRR 1.14 (95% CI: 0.96, 1.35)), immediate skin-to-skin contact increased by 9.92 fold (IRR 9.92 (95% CI: 3.21, 30.64)), early breastfeeding increased by 4.09 fold (IRR 4.09 (95% CI: 2.07, 8.11)), and bag-and-mask within 1 minute increased by 3.30 fold (IRR 3.30 (95% CI: 2.02, 5.40).Conclusion  A synergistic and multi-faceted QI package implementation can improve intrapartum care with a statistically non-significant reduction in intrapartum mortality even during the COVID-19 pandemic.Trial  https://doi.org/10.1186/ISRCTN16741720.
SN  - 2666-5778
ER  -