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Yan SD, S D S, Desai M, Delaney MM, Bobanski L, Rajkumar N, Murthy S, Henrich N. Qualitative assessment of family caregiver-centered neonatal education program in Karnataka, India. PLOS Glob Public Health 2023; 3:e0000524. [PMID: 36962764 PMCID: PMC10022017 DOI: 10.1371/journal.pgph.0000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/12/2023] [Indexed: 02/16/2023]
Abstract
Globally 2.5 million newborns die every year before they reach the age of one month; the majority of these deaths occur in low- and middle-income countries. Among other factors, inadequate knowledge and skills to take care of newborns contribute to these deaths. To fill this gap, training patients and family members on the behaviors needed to improve essential newborn care practices at home is a promising opportunity. One program that aims to do this is the Care Companion Program (CCP) which provides in-hospital, skills-based training on care of mothers and newborns to families. This study uses semi-structured interviews to understand how and why knowledge and behaviors of maternal and newborn care behaviors change (or don't change) as a result of CCP sessions and participants' perception of the impact of CCP on change. Interviews focused on knowledge and behaviors around key neonatal and newborn topics and health seeking behaviors for health complications. Forty-two in-depth interviews were conducted among families with recently-delivered babies at their homes from four districts in Karnataka, India. Respondents have a positive perception about CCP, found training useful and appreciated other family members presence during the training. CCP increased knowledge and awareness and provided critical details to key behaviors like breastfeeding. Respondents were more likely to be receptive toward details on already known topics, like hand washing before touching the baby. Awareness increased on newly learned behaviors, like skin-to-skin care, which don't conflict with cultural norms. The CCP did not influence nonrestrictive maternal diet as much, which cultural norms heavily influence. In-hospital family caregiver education programs, like CCP, can positively influence key neonatal behaviors by imparting knowledge and key skills. However, the effect is not universal across health behaviors.
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Affiliation(s)
- Shirley D Yan
- Noora Health, San Francisco, California, United States of America
| | - Sahana S D
- Aurora Health Innovations, Bengaluru, India
| | - Meghna Desai
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Megan Marx Delaney
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lauren Bobanski
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - N Rajkumar
- Directorate of Health & Family Welfare Services, Bangalore, Karnataka, India
| | | | - Natalie Henrich
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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Delaney MM, Usmanova G, Nair TS, Neergheen VL, Miller K, Fishman E, Bajpai N, Memon P, Bobanski L, Singh D, Srivastava VK, Divakar H, Pai H, Semrau KEA, Pallipamula SP. Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India's Private Sector. Glob Health Sci Pract 2022; 10:GHSP-D-22-00093. [PMID: 36562433 PMCID: PMC9771457 DOI: 10.9745/ghsp-d-22-00093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In India, more than 60% of hospital beds are in private facilities, yet several studies have observed suboptimal quality of care in private facilities. We aimed to understand the role of Manyata, a quality improvement initiative in private facilities focused on mentorship and clinical standards, to improve the knowledge and skills of health care providers, their adherence to key childbirth-related clinical practices, and health outcomes for women and newborns. METHODS We conducted a secondary analysis of Manyata program data collected from 466 private facilities across 3 states (Jharkhand, Maharashtra, and Uttar Pradesh) in India from October 2016 to February 2019. We calculated means and 95% confidence intervals for knowledge and skills assessment, adherence to facility standards was analyzed by calculating the proportion of facilities passing a given quality standard at baseline and endline, and changes in pregnancy outcomes were assessed with autoregression modeling. RESULTS From assessments conducted before and after training among providers in Manyata, we observed a significant increase in average knowledge score (6.3 vs. 13.2 of 20) and skill score (8.0 vs. 34.3 of 40). Overall, a significant increase occurred in adherence to clinical standards between baseline and endline assessments (29% vs. 93%). The standards with the greatest improvements were identification and management of eclampsia/preeclampsia, postpartum hemorrhage, and neonatal resuscitation. There were no significant changes over time in absolute rate of reported complications; however, referral rates from private facilities for preeclampsia and newborn sepsis identification and management declined. CONCLUSION Our analysis indicates private facilities' adherence to quality standards and nurses' childbirth knowledge and practical skills increased during Manyata. Additional efforts are needed to ensure high-quality care during cesarean deliveries at private facilities. Future studies with rigorous design are required to evaluate the impact of this quality improvement initiative in improving pregnancy outcomes.
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Affiliation(s)
- Megan Marx Delaney
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA.,Correspondence to Megan Marx Delaney ()
| | | | | | - Vanessa L. Neergheen
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | - Kate Miller
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | - Eliza Fishman
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Lauren Bobanski
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Hema Divakar
- Manyata Steering Committee, Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Hrishikesh Pai
- Manyata Steering Committee, Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Katherine E. A. Semrau
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA.,Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital; Department of Medicine, Harvard Medical School; Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
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Molina RL, Bobanski L, Dhingra-Kumar N, Moran AC, Taha A, Kumar S, Semrau KEA. The WHO safe childbirth checklist after 5 years: future directions for improving outcomes. The Lancet Global Health 2022; 10:e324-e325. [PMID: 35180407 PMCID: PMC8864300 DOI: 10.1016/s2214-109x(21)00556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 10/31/2022] Open
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Lofgren KT, Bobanski L, Tuller DE, Singh VP, Marx Delaney M, Jurczak A, Ragavan M, Kalita T, Karlage A, Resch SC, Semrau KEA. Estimating maternity ward birth attendant time use in India: a microcosting study. BMJ Open 2022; 12:e054164. [PMID: 35131826 PMCID: PMC8823136 DOI: 10.1136/bmjopen-2021-054164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Despite global concern over the quality of maternal care, little is known about the time requirements to complete the essential birth practices. Using three microcosting data collection methods within the BetterBirth trial, we aimed to assess time use and the specific time requirements to incorporate the WHO Safe Childbirth Checklist into clinical practice. SETTING We collected detailed survey data on birth attendant time use within the BetterBirth trial in Uttar Pradesh, India. The BetterBirth trial tested whether the peer-coaching-based implementation of the WHO Checklist was effective in improving the quality of facility-based childbirth care. PARTICIPANTS We collected measurements of time to completion for 18 essential birth practices from July 2016 through October 2016 across 10 facilities in five districts (1559 total timed observations). An anonymous survey asked about the impact of the WHO Checklist on birth attendants at every intervention facility (15 facilities, 83 respondents) in the Lucknow hub. Additionally, data collectors visited facilities to conduct a census of patients and birth attendants across 20 facilities in seven districts between June 2016 and November 2016 (six hundred and ten 2-hour facility observations). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure of this study is the per cent of staff time required to complete the essential birth practices included in the WHO Checklist. RESULTS When birth attendants were timed, we found practices were completed rapidly (18 s to 2 min). As the patient load increased, time dedicated to clinical care increased but remained low relative to administrative and downtime. On average, WHO Checklist clinical care accounted for less than 7% of birth attendant time use per hour. CONCLUSIONS We did not find that a coaching-based implementation of the WHO Checklist was a burden on birth attendant's time use. However, questions remain regarding the performance quality of practices and how to accurately capture and interpret idle and break time. TRIAL REGISTRATION NUMBER NCT02148952.
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Affiliation(s)
- Katherine T Lofgren
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts, USA
| | - Lauren Bobanski
- Ariadne Labs, Harvard T H Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Danielle E Tuller
- Ariadne Labs, Harvard T H Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vinay P Singh
- Population Services International, Lucknow, India
- Community Empowerment Lab, Lucknow, India
| | - Megan Marx Delaney
- Ariadne Labs, Harvard T H Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amanda Jurczak
- Ariadne Labs, Harvard T H Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Meera Ragavan
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tapan Kalita
- Piramal Swasthya Management and Research Institute, Hyderabad, India
| | - Ami Karlage
- Ariadne Labs, Harvard T H Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephen Charles Resch
- Center for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine E A Semrau
- Ariadne Labs, Harvard T H Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Molina RL, Pichumani A, Tuyishime E, Bobanski L, Semrau KEA. Promising practices for adapting and implementing the WHO Safe Childbirth Checklist: case studies from India and Rwanda. Journal of Global Health Reports 2022. [DOI: 10.29392/001c.30751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rose L. Molina
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center; Ariadne Labs
- Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health
| | | | - Eugene Tuyishime
- Department of Anesthesia and Pain Management, University of Ottawa, Canada; Department of Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda
| | - Lauren Bobanski
- Ariadne Labs
- Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health
| | - Katherine E. A. Semrau
- Ariadne Labs
- Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health; Department of Medicine, Brigham and Women’s Hospital; Division of Global Health Equity, Brigham & Women’s Hospital
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Molina RL, Benski AC, Bobanski L, Tuller DE, Semrau KEA. Adaptation and implementation of the WHO Safe Childbirth Checklist around the world. Implement Sci Commun 2021; 2:76. [PMID: 34238374 PMCID: PMC8268383 DOI: 10.1186/s43058-021-00176-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background The World Health Organization (WHO) published the WHO Safe Childbirth Checklist in 2015, which included the key evidence-based practices to prevent the major causes of maternal and neonatal morbidity and mortality during childbirth. We assessed the current use of the WHO Safe Childbirth Checklist (SCC) and adaptations regarding the SCC tool and implementation strategies in different contexts from Africa, Southeast Asia, Europe, and North America. Methods This explanatory, sequential mixed methods study—including surveys followed by interviews—of global SCC implementers focused on adaptation and implementation strategies, data collection, and desired improvements to support ongoing SCC use. We analyzed the survey results using descriptive statistics. In a subset of respondents, follow-up virtual semi-structured interviews explored how they adapted, implemented, and evaluated the SCC in their context. We used rapid inductive and deductive thematic analysis for the interviews. Results Of the 483 total potential participants, 65 (13.5%) responded to the survey; 55 completed the survey (11.4%). We analyzed completed responses from those who identified as having SCC implementation experience (n = 29, 52.7%). Twelve interviews were conducted and analyzed. Ninety percent of respondents indicated that they adapted the SCC tool, including adding clinical and operational items. Adaptations to structure included translation into local language, incorporation into a mobile app, and integration into medical records. Respondents reported variation in implementation strategies and data collection. The most common implementation strategies were meeting with stakeholders to secure buy-in, incorporating technical training, and providing supportive supervision or coaching around SCC use. Desired improvements included clarifying the purpose of the SCC, adding guidance on relevant clinical topics, refining items addressing behaviors with low adherence, and integrating contextual factors into decision-making. To improve implementation, participants desired political support to embed SCC into existing policies and ongoing clinical training and coaching. Conclusion Additional adaptation and implementation guidance for the SCC would be helpful for stakeholders to sustain effective implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00176-z.
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Affiliation(s)
- Rose L Molina
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, MA, USA. .,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3rd floor, Boston, MA, 02215, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Anne-Caroline Benski
- Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lauren Bobanski
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, MA, USA
| | - Danielle E Tuller
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Subramanian L, Murthy S, Bogam P, Yan SD, Marx Delaney M, Goodwin CDG, Bobanski L, Rangarajan AS, Bhowmik A, Kashyap S, Ramnarayan N, Hawrusik R, Bell G, Kaur B, Rajkumar N, Mishra A, Alam SS, Semrau KEA. Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings. BMJ Glob Health 2021; 5:bmjgh-2020-002660. [PMID: 32727842 PMCID: PMC7394013 DOI: 10.1136/bmjgh-2020-002660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022] Open
Abstract
Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families’ use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families’ use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programmes that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.
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Affiliation(s)
- Laura Subramanian
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Megan Marx Delaney
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christian D G Goodwin
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lauren Bobanski
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Sehj Kashyap
- Center for Biomedical Informatics, Stanford University, Stanford, California, USA
| | | | - Rebecca Hawrusik
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Griffith Bell
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Baljit Kaur
- Directorate of Health Services, Punjab, India
| | - N Rajkumar
- Directorate of Health & Family Welfare Services, Bangalore, Karnataka, India
| | - Archana Mishra
- Directorate of Public Health & Family Welfare, National Health Mission, Madhya Pradesh, India
| | | | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Molina RL, Neal BJ, Bobanski L, Singh VP, Neville BA, Delaney MM, Lipsitz S, Karlage A, Shetye M, Semrau KEA. Nurses' and auxiliary nurse midwives' adherence to essential birth practices with peer coaching in Uttar Pradesh, India: a secondary analysis of the BetterBirth trial. Implement Sci 2020; 15:1. [PMID: 31900167 PMCID: PMC6941293 DOI: 10.1186/s13012-019-0962-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/22/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe Childbirth Checklist for birth attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential birth practices between two different cadres of birth attendants-nurses and auxiliary nurse midwives (ANMs)-during and after a peer coaching intervention for the WHO Safe Childbirth Checklist. METHODS This is a secondary analysis of birth attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through birth attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point). RESULTS Of the 570 birth attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended (p = 0.68). CONCLUSIONS Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of birth attendant competency, the structure, content, and frequency of coaching may need to be customized according to the birth attendant training and competency. TRIAL REGISTRATION ClinicalTrials.gov: NCT2148952; Universal Trial Number: U1111-1131-5647.
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Affiliation(s)
- Rose L Molina
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.
| | - Brandon J Neal
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Lauren Bobanski
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Vinay Pratap Singh
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Lucknow, Uttar Pradesh, 226001, India
| | - Bridget A Neville
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | | | - Stuart Lipsitz
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Ami Karlage
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Mrunal Shetye
- Bill & Melinda Gates Foundation, Capital Court, 5th Floor, Olof Palme Marg, Munirka, Delhi, India
| | - Katherine E A Semrau
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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