Widespread non‐adherence to evidence‐based maternity care guidelines: a population‐based cluster randomised household survey
Objective To assess the quality of maternity care in an Indian metropolitan city. Study design Three‐stage cluster randomised cross‐sectional survey. Setting Sixty selected colonies of Delhi. Population One thousand eight hundred and one subjects (of 2286 eligible) were enrolled from 118 446 houses....
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| Vydané v: | BJOG : an international journal of obstetrics and gynaecology Ročník 122; číslo 2; s. 238 - 247 |
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| Hlavní autori: | , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
Wiley Subscription Services, Inc
01.01.2015
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| ISSN: | 1470-0328, 1471-0528, 1471-0528 |
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| Abstract | Objective
To assess the quality of maternity care in an Indian metropolitan city.
Study design
Three‐stage cluster randomised cross‐sectional survey.
Setting
Sixty selected colonies of Delhi.
Population
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.
Methods
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.
Main outcome measures
Caesarean section rate, induction rate and episiotomy rate.
Results
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.
Conclusion
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. |
|---|---|
| AbstractList | To assess the quality of maternity care in an Indian metropolitan city.
Three-stage cluster randomised cross-sectional survey.
Sixty selected colonies of Delhi.
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.
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.
Caesarean section rate, induction rate and episiotomy rate.
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.
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. To assess the quality of maternity care in an Indian metropolitan city.OBJECTIVETo assess the quality of maternity care in an Indian metropolitan city.Three-stage cluster randomised cross-sectional survey.STUDY DESIGNThree-stage cluster randomised cross-sectional survey.Sixty selected colonies of Delhi.SETTINGSixty selected colonies of Delhi.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.POPULATIONOne 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.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.METHODSIn 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.Caesarean section rate, induction rate and episiotomy rate.MAIN OUTCOME MEASURESCaesarean section rate, induction rate and episiotomy rate.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.RESULTSNational 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.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.CONCLUSIONPresent 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. Objective To assess the quality of maternity care in an Indian metropolitan city. Study design Three-stage cluster randomised cross-sectional survey. Setting Sixty selected colonies of Delhi. Population 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. Methods 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. Main outcome measures Caesarean section rate, induction rate and episiotomy rate. Results 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. Conclusion 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. Objective To assess the quality of maternity care in an Indian metropolitan city. Study design Three‐stage cluster randomised cross‐sectional survey. Setting Sixty selected colonies of Delhi. Population 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. Methods 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. Main outcome measures Caesarean section rate, induction rate and episiotomy rate. Results 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. Conclusion 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. |
| Author | Sengupta Dhar, R Sachdeva, A Bhargava, VL Nagpal, J Bhartia, A |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25145674$$D View this record in MEDLINE/PubMed |
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| Copyright | 2014 Royal College of Obstetricians and Gynaecologists 2014 Royal College of Obstetricians and Gynaecologists. Copyright © 2015 Royal College of Obstetricians and Gynaecologists |
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| Snippet | Objective
To assess the quality of maternity care in an Indian metropolitan city.
Study design
Three‐stage cluster randomised cross‐sectional survey.
Setting... To assess the quality of maternity care in an Indian metropolitan city. Three-stage cluster randomised cross-sectional survey. Sixty selected colonies of... Objective To assess the quality of maternity care in an Indian metropolitan city. Study design Three-stage cluster randomised cross-sectional survey. Setting... To assess the quality of maternity care in an Indian metropolitan city.OBJECTIVETo assess the quality of maternity care in an Indian metropolitan... |
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| SubjectTerms | Adult Caesarean rate Cesarean Section - utilization Cross-Sectional Studies Enema - utilization Episiotomy - utilization Evidence-Based Medicine Female Fluid Therapy - utilization Guideline Adherence - statistics & numerical data Guidelines Health Care Surveys Home Childbirth - standards Home Childbirth - statistics & numerical data Hospitals, Private - standards Hospitals, Private - statistics & numerical data Hospitals, Public - standards Hospitals, Public - statistics & numerical data Humans India Labor, Induced - utilization Labor, Obstetric Maternal & child health maternity care Metropolitan areas Pain Management - utilization Perinatal Care - standards Perinatal Care - statistics & numerical data Practice Guidelines as Topic Pregnancy Prenatal care Prenatal Care - standards Prenatal Care - statistics & numerical data quality of care survey Ultrasonography, Prenatal - utilization Urban Health Services - standards Urban Health Services - statistics & numerical data Young Adult |
| Title | Widespread non‐adherence to evidence‐based maternity care guidelines: a population‐based cluster randomised household survey |
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