Using a quality improvement approach to improve maternal and neonatal care in North Kivu, Democratic Republic of Congo

Figures & data

Table 1. Outcome indicators and data sources

Indicator	Numerator	Denominator	Components	Data source(s)
Percentage of deliveries in facilities with AMTSL^a	No. of women in facilities who receive oxytocin and uterine massage after delivery of placenta	No. of women who delivered in the facility in the same time period	(1) Oxytocin; (2) uterine massage	PEIs
Percentage of newborns born in facilities who receive essential newborn care (ENC)^b	No. of newborns that receive three elements of essential newborn care	No. of newborns delivered in the facility during the same time period	(1) Clean cord care; (2) application of antibiotic to eyes; (3) weight	Matched partographs

Note: North Kivu, DRC 2015–2017.

^aAMTSL: New WHO Recommendations Help to Focus Implementation. WHO, 2014.

^bNewborn Health in Humanitarian Settings Field Guide. UNICEF and Save the Children, New York, 2015.

Table 2. Displacement and delivery characteristics of PEI respondents with matched partographs, by time point

	Baseline (N = 200)	Endline (N = 194)
	n (%)	n (%)
Displaced status  Not displaced  Displaced  Missing	173 (86.50) 24 (12.00) 3 (1.50)	110 (56.70) 84 (43.33) 0 (0.00)
Length of displacement  Displaced, 2 years or less  Displaced, more than 2 years  Missing/do not know	N = 24 15 (62.50) 6 (25.00) 3 (12.50)	N = 84 39 (46.43) 41 (48.81) 4 (4.76)
Mode of transport to health facility for current delivery  By foot  By motorcycle  Other  Missing	157 (78.50) 41 (20.50) 2 (1.00) 0 (0.00)	159 (81.96) 31 (15.98) 3 (1.55) 1 (0.55)
Location preference for current delivery  Current health facility  Other location  Do not know	173 (86.50) 25 (12.50) 2 (1.00)	168 (86.60) 26 (13.40) 0 (0.00)
Location of most recent prior delivery  This facility  Another facility  Home  Other  Missing	N = 170 92 (54.12) 47 (27.65) 12 (7.06) 16 (9.41) 3 (1.76)	N = 171 82 (47.95) 63 (36.84) 12 (7.02) 10 (5.85) 4 (2.34)

Note: North Kivu, DRC 2015–2017.

Table 3. Sociodemographic characteristics by time point

	Baseline (n = 200)	Endline (n = 194)	p-Value
	n (%) or μ(σ)	n (%) or μ (σ)
Mean age^a	25.33 (5.77)	26.8 (6.39)	0.02
Age group^a  18–24  25–34  35+	94 (47.47) 86 (43.43) 18 (9.10)	76 (39.79) 84 (43.98) 31 (16.23)	0.07
Parity Primiparous Multiparous	30 (15.00) 170 (85.00)	23 (11.86) 171 (88.14)	0.36
Mean number of previous births^c	4.8 (2.40)	5.3 (2.45)	0.12
School level  None  Primary  Secondary or greater	45 (22.50) 79 (39.50) 76 (38.00)	32 (16.49) 92 (47.42) 70 (36.08)	0.19
Marital status^b  Married  Single, not cohabiting	182 (91.00) 18 (9.00)	172 (89.12) 21 (10.89)	0.53

Notes: North Kivu, DRC 2015–2017. Bolded values indicate significance at p < .05 level.

^aMissing two observations with unknown or illogical ages at baseline and three at endline.

^bMissing one observation at endline.

^cOnly assessed for multiparous women.

Figure 1. Change within groups between baseline and endline for AMTSL and ENC. North Kivu, DRC 2015–2017

Table 4. GEE outcomes for rate of change of AMTSL, controlling for sociodemographic variables

		AMTSL (n = 376)
		aOR (95% CI)
Time Group Rate of change Age group Marital status Parity School level	Endline vs. baseline QI intervention vs. no QI intervention 25–34 vs. 18–24 35+ vs. 18–24 Single not cohabiting vs. married or cohabiting Primiparous vs. multiparous Primary vs. none Secondary or more vs. none	3.04 (1.73–5.34) 0.57 (0.21–1.53) 3.47 (1.17–10.23) 0.98 (0.66–1.46) 1.29 (0.61–2.69) 1.46 (0.62–3.45) 0.73 (0.39–1.35) 1.10 (0.60–2.02) 1.29 (0.62–2.67)

Notes: North Kivu, DRC 2015–2017. Bolded values indicate significance at the p < .05 level.

Table 5. GEE model for rate of change between baseline and endline for ENC

	OR (95% CI)
Endline vs. baseline Intervention vs. control Rate of change	2.44 (1.28–4.66) 5.02 (2.72–9.28) 49.62 (2.79–888.28)

Note: Bolded values indicate significance at the p < .05 level.