The effect of surveillance and appreciative inquiry on puerperal infections: a longitudinal cohort study in India.
OBJECTIVE
To evaluate the effects of an intervention comprising surveillance and an organisational change called Appreciative Inquiry on puerperal infections in hospitals in Gujarat state, India.


METHODS
This longitudinal cohort study with a control group was conducted over 16 months between 2010 and 2012. Women who delivered in six hospitals were followed-up. After a five month pre-intervention period, the intervention was introduced in three hospitals. Monthly incidence of puerperal infection was recorded throughout the study in all six hospitals. A chi-square test and logistic regression were used to examine for associations, trends and interactions between the intervention and control groups.


RESULTS
Of the 8,124 women followed up, puerperal infections were reported in 319 women (3.9%) over the course of the study. Puerperal sepsis/genital tract infections and urinary tract infections were the two most common puerperal infections. At the end of the study, infection incidence in the control group halved from 7.4% to 3.5%. Levels in the intervention group reduced proportionately even more, from 4.3% to 1.7%. A chi-square test for trend confirmed the reduction of infection in the intervention and control groups (p<0.0001) but the trends were not statistically different from one another. There was an overall reduction of infection by month (OR = 0.94 95% CI 0.91-0.97). Risk factors like delivery type, complications or delivery attendant showed no association with infection.


CONCLUSIONS
Interruption of resource flows in the health system occurred during the intervention phase, which may have affected the findings. The incidence of infection fell in both control and intervention groups during the course of the study. It is not clear if appreciative inquiry contributed to the reductions observed. A number of practical and methodological limitations were faced.


BACKGROUND
Controlled-Trials.com ISRCTN03513186.
Immpact, University of Aberdeen, Aberdeen, Scotland.
Julia
J
Hussein
Indian Institute of Management, Ahmedabad, India.
K V
KV
Ramani
Immpact, University of Aberdeen, Aberdeen, Scotland.
Lovney
L
Kanguru
Indian Institute of Management, Ahmedabad, India.
Kalpesh
K
Patel
Immpact, University of Aberdeen, Aberdeen, Scotland.
Jacqueline
J
Bell
Indian Institute of Management, Ahmedabad, India.
Purvi
P
Patel
Immpact, University of Aberdeen, Aberdeen, Scotland.
Leighton
L
Walker
Indian Institute of Public Health, Gandhinagar, India.
Rajesh
R
Mehta
Indian Institute of Public Health, Gandhinagar, India.
Dileep
D
Mavalankar
D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India; D008137:Longitudinal Studies; D011645:Puerperal Infection / Q000453:epidemiology*; D012307:Risk Factors; D055815:Young Adult