Changes in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting

Abstract

Aim: Quality improvement approaches have been integrated into routine health care in high-resource settings, but not in low-resource settings. We aimed to report the achievements in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting.

Methods: After a first quality assessment in 2012 at Tosamaganga hospital in Tanzania, main areas of intervention were identified and a quality improvement program was implemented. In 2016, a second quality assessment was conducted by the same assessment team by using the World Health Organization’s maternal and neonatal quality of hospital care assessment tool. Some hospital indicators were also collected during the same period.

Results: Access to hospital care, maternity ward and management of maternal complications improved from inadequate to substandard care, alongside with an increment of deliveries from 2145 to 2838 and a substantially stable rate of complicated deliveries (21–26%). The improvements in the maternity ward, maternal complications and emergency care coupled with the reduction of direct obstetric case fatality rate obstetric mortality that dropped from 2.9 to 0.27%. Some neonatal areas (neonatal ward, routine neonatal care, sick newborn care, monitoring, and follow-up) improved from poor to substandard care, while others (infection control and supportive care, emergency care, guidelines protocols, and audit) showed only limited improvements. These changes coupled with a decrease in the perinatal mortality rate from 5.8 to 2.9%.

Conclusion: The quality improvement program resulted in substantial progress in most aspects of quality care, which coupled with a decrease in obstetric and perinatal mortality. Nevertheless, the overall quality of care remained substandard with the limited effect of the intervention on some areas, which require further efforts in order to achieve an acceptable level of care.

Keywords:

• Low-resource setting
• maternal health
• perinatal mortality
• quality improvement
• quality of care

Acknowledgments

We thank the Hospital Management Team and the local staff of Tosamaganga Hospital for their support during the assessment. We thank the evaluation team including Alberta Bacci, Marina Daniele, Paola Stillo, Fabio Uxa, Blandina Reuben Mkumbwike, Monika Gallus Lyelu, Firma Ambros Kisika. We are grateful to the staff of Doctors with Africa CUAMM for providing technical and logistical support during the study period, in particular to Giorgia Soldà, Dominik Metz, Anna Berti, Lorenzo Dal Lago, Giovanni Torelli and all the residents (the Junior Project Officers).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Both first and second assessments were based on funding and technical support by Doctors with Africa CUAMM in the project “Ensuring Access to Safe Delivery in four African Districts through effective and strengthened Public Private Partnership”, with financial contributions from Italian Bank Foundations, Italian Episcopal Conference and Cordaid. The funding sources played no role in the study design, data collection and analysis, and preparation of the manuscript.