Maternal-newborn outcomes in rural Haiti: an interrupted time series study

Objectives In Haiti, efforts to improve maternal newborn child health must be tracked and monitored to measure their success. At a rural Haitian hospital, health system changes took place that resulted in the opening of a newly-constructed maternity unit, with increased personnel, and physical space. We aimed to determine if the new maternity led to improvements in maternal and newborn outcomes. Methods We conducted an interrupted time series analysis using data collected 20 months before, and 20 months after the intervention. We examined maternal-newborn outcomes such as all births, caesarean birth, postpartum hemorrhage (PPH), maternal deaths, stillbirths and all undesirable outcomes (eclampsia, PPH, perineal laceration, postpartum infection, maternal deaths or stillbirths). Results Immediately after the intervention all births decreased by 7.0% (β=-0.070; 95% CI: -0.110 to -0.029; p=0.001) and there was an increase of 6.7% of caesarean births (β=0.067; 95% CI: 0.026 to 0.107; p=0.002). For all undesirable outcomes, preintervention there was an increasing trend of 1.8% (β=0.018; 95% CI: 0.013 to 0.024; p<0.001), an immediate 14.4% decrease of all undesirable outcomes immediately after the intervention (β=-0.144; 95% CI: -0.255 to -0.033; p=0.012), and a decreasing trend of 1.8% through the postintervention period (β=-0.018; 95% CI: -0.026 to -0.009; p<0.001). No other significant level or trend changes were noted. Conclusions The new maternity unit led to an upward trend in caesarean births yet an overall reduction in all undesirable outcomes. The changes at this hospital positively impacted and improved maternal and newborn outcomes.