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Skilled Birth Attendence for A Facility Delivery (SBA)

Complications in pregnancy and childbirth are significant contributors to maternal and neonatal mortality in many of the countries where PSI works. Quality maternity care services can save the lives of women and newborns, but these services require a trained health professional with the skills and resources needed to manage uncomplicated pregnancies and deliveries, as well as to identify and successfully refer women who experience complications. Some PSI-affiliated social franchises provide and support skilled birth attendance in properly equipped facilities where women can give birth and be referred appropriately.

Unit of intervention1 facility delivery

Components (varies by country)Clean birth practices, labor and delivery management, MgSO4 for eclampsia, active management of third stage of labor (AMTSL), immediate assessment and stimulation of the newborn

Target population Pregnant women and neonates

For more information about how PSI is improving health and saving lives of mothers and their children, visit our website at:
http://www.psi.org/health-area/maternal-health/

Model Overview

PSI’s skilled birth attendance (SBA) impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted by providing skilled birth attendance for a facility delivery. Skilled birth attendance in a facility includes many components, and these components are all scaled-up simultaneously in LiST to provide a population level estimate of impact. This number of deaths averted at the population level is translated to deaths averted per facility delivery, using country specific parameters such as population size and the number of live births. Once we have deaths averted per delivery, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples of SBA usage in Uganda in 2014 Statement of modeled results, examples:

In 2014, an estimated 44 deaths and 2393 DALYs would be averted if 10,000 facility deliveries were attended by a skilled provider in Uganda.

For more details about how PSI models SBA impact, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for select countries. We model multiple interventions simultaneously in order to capture the impact of the full range of interventions available at a facility delivery with a skilled attendant. In LiST, this includes: clean birth practices, immediate assessment and stimulation, labor and delivery management, magnesium sulfate for management of eclampsia, and active management of the third stage of labor. In this projection, access to all of these interventions is increased from the current, country-specific baseline to 100% at the “Essential Care” level of delivery in LiST. LiST then projects the number of deaths averted among neonates and mothers by this increased level of coverage.

Step 1 Output:
Number of additional deaths averted (or lives saved) among mothers and neonates if coverage of SBA is increased from baseline to 100%

Step 2: Estimating deaths averted per facility deliveryPSI uses the step 1 output (deaths averted at 100% coverage of skilled birth attendance) to estimate the number of deaths averted by a single attended birth in a facility. To do this, we divide the number of deaths averted by increasing to 100% coverage by the number of additional facility deliveries needed to reach 100% coverage of births. PSI estimates the number of facility deliveries needed to reach 100% coverage using a number of parameters, including baseline coverage of the interventions and the number of births in a year.

Step 2 Output:
Maternal and neonatal deaths averted coefficient for SBA

Step 3: Estimating DALYs averted per facility delivery among mothers and neonatesA DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per facility delivery among mothers and neonates, PSI first estimates the number of years of life lost per death among mothers and neonates due to the causes impacted by the interventions. This includes: maternal sepsis, maternal hemorrhage, hypertensive disorders of pregnancy, preterm birth complications, neonatal encephalopathy, and sepsis and other infectious disorders of the newborn baby. This is equal to the life expectancy at the average age of death from each of these causes. Age specific life expectancies are taken from the 2010 Global Burden of Disease study (GBD 2010). The number of years of life lost per maternal and neonatal death is then multiplied by the number of deaths averted per facility delivery among mothers and neonates (maternal and neonatal deaths averted coefficients), calculated in step 2 above for a selected country. This gives us the YLLs averted per facility delivery.

To estimate YLDs averted per facility delivery among mothers neonates, we use a YLD/YLL ratio, based on the 2010 GBD. This ratio represents the relative number of years lived with disability for every year lost due to death from the maternal or neonatal causes. We apply this ratio to the number of YLLs averted per facility to estimate the number of YLDs averted per facility delivery among mothers and neonates.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted per facility delivery among neonates.

Step 3 Output:
Maternal and neonatal DALYs averted coefficient for SBA