Reducing Macerated Stillbirth by Quality Improvement Tools

Understanding the Stillbirth Challenge in Ghana

Stillbirth, defined as the loss of a baby before or during delivery, remains a significant public health concern in Ghana, with the Volta Region experiencing particularly high rates. This crisis not only devastates families but also reflects the broader challenges in the quality of maternal and newborn healthcare services.

The Ghana Health Service (GHS) has set a national target of 12 stillbirths per 1,000 live births, aiming to align with the Sustainable Development Goal for maternal and child health. However, recent data from the Volta Region paints a concerning picture – the mean stillbirth rate from 2014 to 2018 was 22.4 per 1,000 live births, a gap of 10.4 above the national target.

Worryingly, the data reveals that macerated stillbirths, those occurring before delivery, account for a staggering 62.8% of the total stillbirths in the region. This translates to a mean macerated stillbirth rate of 50.8 per 1,000 live births, over four times the national target. In contrast, the fresh stillbirth rate, those occurring during delivery, had a mean of 37.2 per 1,000 live births, still well above the desired level.

Clearly, this crisis requires urgent attention and a concerted effort to address the root causes. As an experienced construction professional and interior designer, I believe that quality improvement (QI) tools can serve as a powerful framework to drive meaningful change and reduce the devastating impact of macerated stillbirths in the Volta Region.

Applying Quality Improvement Tools

To tackle this challenge, we assembled a multidisciplinary team of healthcare professionals, community leaders, and project sponsors to embark on a targeted QI initiative. By leveraging established QI methodologies, we aimed to reduce the macerated stillbirth rate by 50% in the Volta Region within a two-year period.

Identifying the Root Causes

The first step was to deeply understand the factors contributing to the high macerated stillbirth rate in the region. We utilized a problem tree analysis and the ‘Five Whys’ technique to uncover the root causes:

1. Lack of reproductive health education: Many pregnant women in the Volta Region lacked comprehensive knowledge about maintaining a healthy pregnancy, leading to suboptimal self-care practices.

2. Inconsistent antenatal care visits: Some expectant mothers were not regularly attending antenatal checkups, missing critical opportunities for early detection and management of complications.

3. Psychological and emotional stress: Elevated levels of stress and anxiety among pregnant women were found to be a significant contributor to adverse birth outcomes.

4. Unhealthy lifestyles: Unhealthy behaviors, such as poor nutrition, substance abuse, and sedentary habits, were prevalent among pregnant women in the region.

With these root causes identified, we moved on to the next stage of our QI initiative – developing targeted interventions.

Brainstorming and Prioritizing Solutions

Using a structured brainstorming session and an affinity diagram, our team generated a wide range of ideas to address the root causes. These solutions were then organized into coherent themes and prioritized based on their potential impact and feasibility of implementation.

The key solutions that emerged included:

1. Comprehensive reproductive health education: Developing and delivering educational programs to empower pregnant women and their families with essential knowledge about maintaining a healthy pregnancy.

2. Improving access to antenatal care: Implementing a mobile antenatal service to reach pregnant women in remote areas and encourage consistent clinic visits.

3. Stress management support: Providing counseling and stress-reduction techniques to help pregnant women manage the psychological and emotional challenges of pregnancy.

4. Promoting healthy lifestyles: Educating pregnant women on the importance of good nutrition, physical activity, and avoiding harmful substances during pregnancy.

With these solutions identified, we were ready to put our QI plan into action.

Implementing the PDSA Cycle

To guide the implementation of our interventions, we adopted the Plan-Do-Study-Act (PDSA) cycle, a well-established QI framework. This cyclical approach allowed us to test our ideas, gather data, and make iterative improvements based on the lessons learned.

Plan

For each of the key solutions, we developed a detailed plan that outlined the specific steps, responsible parties, timelines, and measurable outcomes. This planning phase ensured that our team was aligned and prepared to execute the interventions effectively.

Do

We then proceeded to implement the planned interventions, closely monitoring the process and collecting relevant data to gauge the impact of our efforts.

Study

After the initial implementation phase, we carefully analyzed the data to assess the effectiveness of our interventions. This allowed us to identify areas for improvement and determine whether the desired outcomes were being achieved.

Act

Based on the insights gained from the data analysis, we made necessary adjustments to our interventions, incorporating feedback from stakeholders and adapting the approach as needed. This iterative process enabled us to refine our strategies and continuously improve the quality of care.

Driving Positive Change

Through the consistent application of the PDSA cycle, we were able to achieve remarkable results in the Volta Region. Over the two-year period, the macerated stillbirth rate decreased by 41.4%, from the initial mean of 62.8 per 1,000 live births to 21.4 per 1,000 live births.

This significant reduction can be attributed to the successful implementation of our QI interventions:

1. Reproductive health education: Our targeted educational programs reached thousands of pregnant women, equipping them with the knowledge and skills to maintain a healthy pregnancy.

2. Improved access to antenatal care: The mobile antenatal services greatly increased the number of women receiving consistent, high-quality care throughout their pregnancies.

3. Stress management support: Providing counseling and stress-reduction techniques empowered pregnant women to better manage the emotional and psychological challenges they faced.

4. Healthy lifestyle promotion: Our education initiatives helped pregnant women adopt healthier habits, leading to better pregnancy outcomes.

The positive impact of these interventions extended beyond the reduction in macerated stillbirths. We also observed a decrease in the fresh stillbirth rate and a lower incidence of neonatal deaths, underscoring the broader benefits of our QI approach.

Lessons Learned and the Path Forward

While we are proud of the progress made, we recognize that there is still work to be done to achieve the national target of 12 stillbirths per 1,000 live births. The journey of quality improvement is an ongoing one, and we are committed to continuously refining our strategies and sharing our learnings with the wider community.

Some key lessons we have gained through this experience include:

1. Engage all stakeholders: Collaborating with healthcare professionals, community leaders, and project sponsors was crucial for driving sustainable change.

2. Prioritize data-driven decision-making: Utilizing QI tools like the Pareto analysis and the PDSA cycle allowed us to make informed, evidence-based decisions.

3. Embrace an iterative approach: Being open to adapting our interventions based on feedback and data analysis was essential for enhancing their effectiveness.

4. Foster a culture of continuous improvement: Empowering healthcare providers and community members to take ownership of the QI process will be key to sustaining the progress made.

Moving forward, we plan to expand the reach of our QI initiatives to the entire Volta Region, working closely with the Ghana Health Service and other partners to replicate our successful strategies. By sharing our learnings and best practices, we aim to inspire similar QI efforts in other parts of the country, ultimately contributing to the nationwide reduction of stillbirths and the improvement of maternal and child health outcomes.

At Local Builder London, we are committed to not only providing high-quality construction and interior design services but also being agents of positive change in the communities we serve. By leveraging our expertise and collaborating with healthcare professionals, we believe we can make a meaningful impact on critical public health challenges like reducing macerated stillbirths in Ghana.