Using statistical process control methods to trace small changes in perinatal mortality after a training program in a low-resource setting

Objective: To trace and document smaller changes in perinatal survival over time. Design: Prospective observational study, with retrospective analysis. Setting: Labor ward and operating theater at Haydom Lutheran Hospital in rural north-central Tanzania. Participants: All women giving birth and birth attendants. Intervention: Helping Babies Breathe (HBB) simulation training on newborn care and resuscitation and some other efforts to improve perinatal outcome. Main outcome measure: Perinatal survival, including fresh stillbirths and early (24-h) newborn survival. Result: The variable life-adjusted plot and cumulative sum chart revealed a steady improvement in survival over time, after the baseline period. There were some variations throughout the study period, and some of these could be linked to different interventions and events. Conclusion: To our knowledge, this is the first time statistical process control methods have been used to document changes in perinatal mortality over time in a rural Sub-Saharan hospital, showing a steady increase in survival. These methods can be utilized to continuously monitor and describe changes in patient outcomes.