A retrospective observational study of obstetric care in rural Andhra Pradesh by Dangoria Charitable Trust (1979 to 2009)

BACKGROUND & OBJECTIVES: In India several models of health care delivery have been explored to increase access to skilled obstetric care in rural areas, where there is a lack of specialists and appropriate facilities. We present here an innovative and affordable approach to the delivery of antenatal and obstetric care provided by the Dangoria Charitable Trust (DCT) since 1979, twinning a not-for-profit hospital in rural Andhra Pradesh with a for-profit one in the capital Hyderabad. METHODS: A retrospective observational study of a random sample of the deliveries performed from 1979 to 2009 by the Dangoria Charitable Trust, based on the maternity hospital birth register, was conducted. The profile of mothers, such as their age, parity and previous miscarriages, as well as type of delivery, gender and birth weight of the newborn, and frequency of stillbirths and in hospital deaths as they evolved over time were presented using simple descriptive methods. The risk of stillbirth and in hospital death over time was explored by logistic regression after allowance for selected factors. RESULTS: From 1979 to 2009 the cumulative number of deliveries at the Narsapur maternity hospital was 9333, from a few dozens per year in the early 1980s to over 1000 in 2009. The number of primiparae significantly increased over time, while the percentage of low birth weight babies (less than 2.5 kg) did not change appreciably. Caesarean section increased significantly over time, from 8.6 per cent in the first decade to 20.3 per cent in the last. The risk of death (stillbirths and in hospital death) consistently decreased over time, reaching 15 per thousand in the last decade. The results of a logistic regression adjusted for potential confounders showed that low birth weight babies had 4 times the risk of dying as compared to those weighing 2.5 kg or above. CONCLUSIONS: Over the 30 year period the percentage of babies discharged alive from DCT improved considerably. Caesarean sections increased significantly from the first decade to the third decade. The model adopted by the DCT to improve maternal and child health in rural areas could be replicated in other rural parts of the country.