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

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Study Justification:
– Quality improvement approaches have been successful in high-resource settings but have not been widely implemented in low-resource settings.
– This study aimed to assess the impact of a quality improvement intervention on maternal and neonatal care in a sub-Saharan setting.
– The findings of this study can inform future efforts to improve healthcare in similar settings.
Highlights:
– Access to hospital care, maternity ward, and management of maternal complications improved from inadequate to substandard care.
– Deliveries increased from 2145 to 2838, with a stable rate of complicated deliveries.
– Maternal mortality rate dropped from 2.9% to 0.27%.
– Some areas of neonatal care, such as neonatal ward and routine care, improved from poor to substandard care.
– Perinatal mortality rate decreased from 5.8% to 2.9%.
Recommendations:
– Further efforts are needed to improve areas that showed limited improvements, such as infection control, emergency care, guidelines protocols, and audit.
– Continued focus on quality improvement interventions to achieve an acceptable level of care.
– Consideration of scaling up the successful interventions to other healthcare facilities in the region.
Key Role Players:
– Hospital administrators and management
– Healthcare providers and staff
– Quality improvement experts or consultants
– Ministry of Health officials
– Community leaders and representatives
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers
– Equipment and supplies for improved care
– Monitoring and evaluation systems
– Quality improvement program implementation costs
– Community engagement and awareness campaigns
– Support for data collection and analysis

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.

Innovations for improving access to maternal health based on the recommendations from the study include:

1. Implementing a quality improvement program: This program should focus on addressing the main areas of intervention identified through a quality assessment. It should aim to improve access to hospital care, maternity ward facilities, management of maternal complications, and neonatal care.

2. Prioritizing specific areas: The program should prioritize areas such as infection control, supportive care, emergency care, guidelines protocols, and audit, which showed limited improvements in the study. By focusing on these areas, it is expected to achieve substantial progress in most aspects of quality care.

3. Improving access to hospital care: Efforts should be made to ensure that pregnant women have access to hospital care when needed. This may involve improving transportation systems, increasing the number of healthcare facilities in low-resource settings, and providing financial support for healthcare services.

4. Enhancing maternity ward facilities: Maternity ward facilities should be improved to provide a safe and comfortable environment for pregnant women. This may include renovating existing facilities, providing necessary equipment and supplies, and ensuring a sufficient number of skilled healthcare providers.

5. Strengthening management of maternal complications: Efforts should be made to improve the management of maternal complications during pregnancy, childbirth, and the postpartum period. This may involve training healthcare providers on emergency obstetric care, ensuring the availability of essential drugs and equipment, and establishing referral systems for complicated cases.

6. Enhancing neonatal care: Neonatal care should be improved to ensure the well-being of newborns. This may involve training healthcare providers on newborn care practices, improving neonatal ward facilities, and ensuring access to necessary equipment and medications.

By implementing these innovations, it is expected to achieve significant improvements in maternal and neonatal care, leading to a decrease in obstetric and perinatal mortality rates. However, further efforts may be required to reach an acceptable level of care.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health is to implement a quality improvement program in low-resource settings. This program should focus on addressing the main areas of intervention identified through a quality assessment. The program should aim to improve access to hospital care, maternity ward facilities, management of maternal complications, and neonatal care. Additionally, it should prioritize areas such as infection control, supportive care, emergency care, guidelines protocols, and audit, which showed limited improvements in the study. By implementing this recommendation, it is expected to achieve substantial progress in most aspects of quality care, leading to a decrease in obstetric and perinatal mortality rates. Further efforts may be required to reach an acceptable level of care. This recommendation is based on the findings of the study titled “Changes in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting” published in the Journal of Maternal-Fetal and Neonatal Medicine in 2020.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the study population: Determine the target population for the simulation, such as pregnant women in low-resource settings.

2. Identify the main areas of intervention: Based on the findings of the study, identify the main areas of intervention that need improvement, such as access to hospital care, maternity ward facilities, management of maternal complications, and neonatal care.

3. Establish baseline data: Gather baseline data on the current state of maternal health in the selected low-resource settings. This could include information on maternal mortality rates, perinatal mortality rates, access to hospital care, availability of maternity ward facilities, and the quality of care provided.

4. Design the quality improvement program: Develop a comprehensive quality improvement program based on the recommendations from the study. This program should include specific interventions and strategies to address the identified areas of improvement. For example, it could include training healthcare providers on infection control practices, improving emergency care protocols, and implementing guidelines for managing maternal complications.

5. Implement the quality improvement program: Roll out the quality improvement program in the selected low-resource settings. Ensure that all relevant stakeholders, including healthcare providers, administrators, and policymakers, are involved in the implementation process.

6. Monitor and evaluate the program: Continuously monitor and evaluate the impact of the quality improvement program. Collect data on key indicators such as maternal mortality rates, perinatal mortality rates, access to hospital care, and the quality of care provided. Compare these indicators to the baseline data to assess the program’s effectiveness.

7. Analyze the results: Analyze the data collected to determine the impact of the quality improvement program on improving access to maternal health. Assess the changes in maternal and neonatal care, as well as any improvements in the identified areas of intervention.

8. Draw conclusions and make recommendations: Based on the analysis of the results, draw conclusions about the effectiveness of the quality improvement program. Identify any remaining gaps or areas that require further attention. Make recommendations for future interventions or modifications to the program to achieve an acceptable level of care.

By following this methodology, researchers and policymakers can simulate the impact of the main recommendations from the study on improving access to maternal health in low-resource settings. This will help guide the development and implementation of effective interventions to reduce maternal and perinatal mortality rates and improve the overall quality of care provided.

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