Assessing the Effect of Integrated Health Interventions on Maternal And Neonatal Health Outcomes in an Aspirational District of Uttar Pradesh: A Mixed Method Study

Abstract

Background: Maternal and neonatal mortality remain major public health challenges in India, particularly in aspirational districts like Shrawasti, Uttar Pradesh. Birth asphyxia and postpartum haemorrhage (PPH) are leading causes of preventable deaths, necessitating integrated interventions to improve outcomes.

Objective: To assess the effect of integrated interventions on maternal and neonatal health outcomes, with focus on birth asphyxia and PPH, and to compare pre- and post-intervention complications in Shrawasti.

Methods: A retrospective observational study analyzed quantitative data from labour rooms of the District Hospital, four Community Health Centres, and the Special Newborn Care Unit (SNCU) in Shrawasti. Qualitative insights were derived from in-depth interviews with healthcare providers. Interventions were implemented based on baseline findings and evaluated using systematically organized data collected between June 2022 and May 2023, covering a population of ~1.1 million (Census 2011).

Results: Significant improvements were observed following interventions. SNCU admissions due to perinatal asphyxia declined from 67% to 42.3% (P <0.001). Stillbirths reduced from 3.5% to 1.9% (P = 0.001), while PPH decreased from 6.6% to 3.9% (P <0.001). Neonatal mortality also showed a declining trend (22.6% to 17.9%). Qualitative findings highlighted rational oxytocin use, effective training, improved staff behaviour, enhanced patient awareness, and strengthened documentation as key contributors to improved outcomes.

Conclusion: Integrated interventions substantially improved maternal and neonatal health in Shrawasti. Addressing misuse of oxytocin, strengthening training, enhancing awareness, and improving documentation were pivotal in reducing adverse outcomes. Targeted, context-specific approaches can significantly improve maternal and newborn survival in resource-limited settings.

Keywords: Birth Asphyxia, Healthcare Interventions, Maternal Health, Neonatal Health, Postpartum Hemorrhage