Obstetric care in Mali: Effect of organization on in-hospital maternal mortality

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Study Justification:
– Maternal mortality rates in sub-Saharan Africa, particularly in referral hospitals, are still unacceptably high.
– Implementation of solutions to reduce maternal mortality is challenging in resource-limited settings.
– This study aims to assess the impact of the organization of obstetric care services on maternal mortality in referral hospitals in Mali.
Study Highlights:
– Multicentric observational survey conducted in 22 referral hospitals in Mali.
– Clinical data collected on 42,929 women delivering within the study period.
– Evaluation of organization based on explicit criteria defined by an expert committee.
– Optimal organization of obstetric care services reduced in-hospital maternal mortality by 41% compared to sub-optimal organization.
– Local policies improving financial access to emergency obstetric care had a significant impact on maternal outcomes.
Study Recommendations:
– Implement an optimal organization of obstetric care services based on eight explicit criteria.
– Ensure management of labor and childbirth by qualified personnel.
– Establish an organization of human resources that allows timely management of obstetric emergencies.
– Promote routine use of partography for all patients.
– Provide guidelines for the management of complications.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Referral Hospitals: Responsible for implementing changes in organization and care practices.
– Obstetricians and Midwives: Responsible for providing qualified personnel and adhering to guidelines.
– Health Administrators: Responsible for allocating resources and monitoring implementation.
Cost Items for Planning Recommendations:
– Training and Capacity Building: Budget for training healthcare providers on optimal obstetric care practices.
– Equipment and Supplies: Budget for procuring necessary equipment and supplies for obstetric care.
– Infrastructure Improvement: Budget for renovating and upgrading facilities to meet optimal organization criteria.
– Monitoring and Evaluation: Budget for establishing systems to monitor and evaluate the implementation and impact of changes.
Note: The actual cost estimates for these items are not provided.

Background: Maternal mortality is still too high in sub-Saharan Africa, particularly in referral hospitals. Solutions exist but their implementation is a great issue in the poor-resources settings. The objective of this study is to assess the effect of the organization of obstetric care services on maternal mortality in referral hospitals in Mali. Methods: This is a multicentric observational survey in 22 referral hospitals. Clinical data on 42,929 women delivering in the 22 hospitals within the 2007 to 2008 study period were collected. Organization evaluation was based on explicit criteria defined by an expert committee. The effect of the organization on in-hospital mortality adjusted on individual and institutional characteristics was estimated using multi-level logistic regression models. Results: The results show that an optimal organization of obstetric care services based on eight explicit criteria reduced in-hospital maternal mortality by 41% compared with women delivering in a referral hospital with sub-optimal organization defined as non-compliance with at least one of the eight criteria (ORa = 0.59; 95% CI = 0.34-0.92). Furthermore, local policies that improved financial access to emergency obstetric care had a significant impact on maternal outcome. Conclusion: Criteria for optimal organization include the management of labor and childbirth by qualified personnel, an organization of human resources that allows timely management of obstetric emergencies, routine use of partography for all patients and availability of guidelines for the management of complications. These conditions could be easily implemented in the context of Mali to reduce in-hospital maternal mortality. © 2012 Elsevier Masson SAS.

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Based on the study titled “Obstetric care in Mali: Effect of organization on in-hospital maternal mortality,” the following innovations can be developed to improve access to maternal health:

1. Implementing a system of training and certification for healthcare providers attending to pregnant women, ensuring that they are properly trained and qualified to handle obstetric emergencies. This can improve the quality of care provided during labor and childbirth.

2. Developing a system for efficient allocation and management of human resources in referral hospitals, ensuring that there are enough healthcare professionals available to provide timely care during obstetric emergencies. This can help reduce delays in accessing care and improve outcomes.

3. Introducing the routine use of partography, a tool that helps monitor the progress of labor and identify any complications early on. This can improve the timely management of complications and reduce maternal mortality.

4. Establishing clear and up-to-date guidelines for the management of obstetric complications, ensuring that healthcare providers have access to standardized protocols for providing care. This can improve the consistency and quality of care provided to pregnant women.

In addition to these innovations, local policies should be developed to improve financial access to emergency obstetric care. This can include measures such as providing financial assistance or insurance coverage for pregnant women, ensuring that they have the means to seek timely and appropriate care when needed.

By implementing these innovations, it is expected that in-hospital maternal mortality rates can be significantly reduced, improving access to maternal health in Mali.
AI Innovations Description
Based on the study titled “Obstetric care in Mali: Effect of organization on in-hospital maternal mortality,” the following recommendation can be developed into an innovation to improve access to maternal health:

Implement an optimal organization of obstetric care services in referral hospitals, based on explicit criteria defined by an expert committee. This includes:

1. Management of labor and childbirth by qualified personnel: Ensure that healthcare providers attending to pregnant women are properly trained and qualified to handle obstetric emergencies.

2. Organization of human resources: Establish a system that allows for timely management of obstetric emergencies, ensuring that there are enough healthcare professionals available to provide care when needed.

3. Routine use of partography: Implement the use of partography, a tool that helps monitor the progress of labor and identify any complications early on. This can improve the timely management of complications and reduce maternal mortality.

4. Availability of guidelines for the management of complications: Ensure that healthcare providers have access to clear and up-to-date guidelines on how to manage obstetric complications. This can help standardize care and improve outcomes.

Additionally, local policies should be developed to improve financial access to emergency obstetric care. This can help ensure that pregnant women have the means to seek timely and appropriate care when needed, reducing the risk of maternal mortality.

By implementing these recommendations, it is expected that in-hospital maternal mortality rates can be significantly reduced, improving access to maternal health in Mali.
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: Identify the target population for the simulation, such as pregnant women in referral hospitals in Mali.

2. Collect baseline data: Gather data on the current state of obstetric care services in the selected referral hospitals. This includes information on the organization of care, availability of qualified personnel, use of partography, and access to guidelines for managing complications.

3. Develop a simulation model: Create a mathematical model that simulates the impact of implementing the main recommendations on access to maternal health. This model should take into account factors such as the number of qualified personnel, availability of resources, adherence to guidelines, and financial access to emergency obstetric care.

4. Input data: Input the collected baseline data into the simulation model to establish the starting point for the simulation.

5. Implement the recommendations: Modify the simulation model to reflect the implementation of the main recommendations, such as ensuring qualified personnel, organizing human resources, using partography, and providing guidelines for managing complications.

6. Run the simulation: Execute the simulation model to simulate the impact of the recommendations on access to maternal health. This can be done by comparing the outcomes of the simulation with the baseline data.

7. Analyze the results: Evaluate the results of the simulation to determine the potential impact of implementing the recommendations. This can include assessing changes in maternal mortality rates, improvements in access to obstetric care, and any other relevant outcomes.

8. Interpret the findings: Interpret the findings of the simulation to understand the potential benefits and limitations of implementing the recommendations. This can help inform decision-making and guide the development of interventions to improve access to maternal health.

It is important to note that the simulation methodology may require additional data collection, validation, and refinement to ensure accuracy and reliability. Additionally, the simulation results should be interpreted with caution and considered alongside other evidence and contextual factors when making decisions about implementing the recommendations.

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