Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana

  • International Journal of Gynecology and Obstetrics, Volume 123, No. 1, Year 2013

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Study Justification:
– The study aimed to assess the baseline incidence of maternal near-miss, process indicators related to facility access, and quality of care at a tertiary care facility in urban Ghana.
– This study is important because it provides valuable information on the current state of maternal health care in Ghana and identifies areas for improvement.
– By understanding the incidence of maternal near-miss and the quality of care provided, policymakers and healthcare professionals can develop targeted interventions to reduce maternal mortality and improve overall maternal health outcomes.
Study Highlights:
– The study included 3438 women who delivered at the facility, with 516 having potentially life-threatening conditions and 131 experiencing severe maternal outcomes (94 near-miss cases and 37 maternal deaths).
– More than half of the women (64.4%) had been referred to the facility, indicating potential issues with access to care.
– The incidence of maternal near-miss was found to be 28.6 cases per 1000 live births.
– Anemia was identified as a significant contributor to severe maternal outcomes.
– More than half of the women with severe maternal outcomes developed organ dysfunction or died within the first 12 hours of hospital admission.
– Preventive measures were prevalent, but treatment-related indicators showed mixed results.
Recommendations:
– Improve referral systems to ensure timely access to appropriate care for women with pregnancy-related complications.
– Enhance the effective use of critical care to address organ dysfunction and reduce maternal mortality.
– Implement evidence-based interventions to prevent and manage anemia in pregnant women.
– Strengthen the quality of care provided by healthcare professionals through training and adherence to best practices.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation of interventions to improve maternal health outcomes.
– Tertiary Care Facility: Plays a crucial role in providing quality care and implementing recommended interventions.
– Healthcare Professionals: Responsible for delivering care and implementing evidence-based interventions.
– Community Health Workers: Involved in referral systems and community education on maternal health.
Cost Items for Planning Recommendations:
– Training programs for healthcare professionals on critical care and evidence-based interventions.
– Development and implementation of referral system improvements.
– Provision of necessary equipment and resources for critical care.
– Community education programs on maternal health.
– Monitoring and evaluation of interventions to ensure effectiveness.
Please note that the cost items provided are examples and may not reflect the actual cost of implementing the recommendations.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is a prospective observational study conducted at a tertiary care facility in urban Ghana, which provides valuable insights into the baseline incidence of maternal near-miss and the quality of care. The study includes a large sample size of 3438 women and utilizes a newly developed WHO instrument based on near-miss criteria and criterion-based clinical audit methodology to assess the quality of maternal health care. However, the study only covers a specific time period between October 2010 and March 2011, which may limit the generalizability of the findings. To improve the strength of the evidence, future studies could consider conducting a longer-term study to capture a wider range of data and include multiple healthcare facilities to enhance the representativeness of the findings.

Objective To assess the baseline incidence of maternal near-miss, process indicators related to facility access, and quality of care at a tertiary care facility in urban Ghana. Methods A prospective observational study of all women delivering at the facility, including those with pregnancy-related complications, was conducted between October 2010 and March 2011. Quality of maternal health care was assessed via a newly developed WHO instrument based on near-miss criteria and criterion-based clinical audit methodology. Results Among 3438 women, 516 had potentially life-threatening conditions and 131 had severe maternal outcomes (94 near-miss cases and 37 maternal deaths). More than half (64.4%) of the women had been referred to the facility. The incidence of maternal near-miss was 28.6 cases per 1000 live births. Anemia contributed to most cases with a severe maternal outcome. More than half of all women with severe maternal outcomes developed organ dysfunction or died within the first 12 hours of hospital admission. Although preventive measures were prevalent, treatment-related indicators showed mixed results. Conclusion The WHO near-miss approach was found to represent a feasible strategy in low-resource countries. Improving referral systems, effective use of critical care, and evidence-based interventions can potentially reduce severe maternal outcomes. © 2013 International Federation of Gynecology and Obstetrics.

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Innovation 1: Strengthening Referral Systems
– Establish clear communication channels for efficient transfer of pregnant women with complications.
– Train healthcare providers on referral protocols to ensure timely and appropriate referrals.
– Improve transportation infrastructure to facilitate the transfer of pregnant women to tertiary care facilities.

Innovation 2: Implementing Critical Care Units
– Establish dedicated critical care units within tertiary care facilities to provide specialized care for pregnant women with life-threatening conditions.
– Equip these units with necessary medical equipment and trained staff.
– Develop protocols for managing obstetric emergencies in critical care units.

Innovation 3: Promoting Evidence-Based Interventions
– Ensure the adoption and implementation of evidence-based interventions for preventing and managing complications during pregnancy and childbirth.
– Focus on interventions such as early detection and management of anemia, proper administration of blood transfusions, and timely administration of antibiotics to prevent infections.

Innovation 4: Conducting Regular Quality Audits
– Implement a regular quality audit system based on the WHO near-miss criteria to assess the quality of maternal health care provided in the facility.
– Identify gaps and areas for improvement through quality audits.
– Use the findings to enhance overall care and outcomes for pregnant women.

Innovation 5: Enhancing Health Information Systems
– Improve the collection, analysis, and utilization of data related to maternal health outcomes.
– Implement robust health information systems that capture relevant indicators.
– Use the data for better monitoring and evaluation of maternal health programs and interventions.
AI Innovations Description
Based on the study titled “Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Referral Systems: Enhance the existing referral systems to ensure timely and efficient transfer of pregnant women with complications to tertiary care facilities. This can be achieved by establishing clear communication channels, training healthcare providers on referral protocols, and improving transportation infrastructure.

2. Implementing Critical Care Units: Establish dedicated critical care units within tertiary care facilities to provide specialized care for pregnant women with life-threatening conditions. These units should be equipped with the necessary medical equipment, trained staff, and protocols for managing obstetric emergencies.

3. Promoting Evidence-Based Interventions: Ensure the adoption and implementation of evidence-based interventions for preventing and managing complications during pregnancy and childbirth. This can include interventions such as early detection and management of anemia, proper administration of blood transfusions, and timely administration of antibiotics to prevent infections.

4. Conducting Regular Quality Audits: Implement a regular quality audit system based on the WHO near-miss criteria to assess the quality of maternal health care provided in the facility. This will help identify gaps and areas for improvement, leading to better overall care and outcomes for pregnant women.

5. Enhancing Health Information Systems: Improve the collection, analysis, and utilization of data related to maternal health outcomes. This can be achieved by implementing robust health information systems that capture relevant indicators, allowing for better monitoring and evaluation of maternal health programs and interventions.

By implementing these recommendations, access to maternal health can be improved, leading to a reduction in severe maternal outcomes and better overall maternal health outcomes in low-resource settings like Accra, Ghana.
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. Baseline Data Collection: Gather data on the current state of maternal health access in the target area, including information on referral systems, critical care units, evidence-based interventions, quality of care, and health information systems. This can be done through surveys, interviews, and data collection from healthcare facilities.

2. Modeling the Impact: Use the collected data to create a simulation model that represents the current state of maternal health access. This model should include variables such as the number of referrals, availability of critical care units, implementation of evidence-based interventions, quality of care indicators, and health information system utilization.

3. Implementing the Recommendations: Introduce the recommended interventions into the simulation model. This can involve adjusting variables such as the efficiency of referral systems, the presence of critical care units, the utilization of evidence-based interventions, and the improvement of health information systems.

4. Simulating the Impact: Run the simulation model with the implemented recommendations to assess the potential impact on improving access to maternal health. Measure indicators such as the reduction in severe maternal outcomes, improvement in referral rates, utilization of critical care units, adherence to evidence-based interventions, and the effectiveness of health information systems.

5. Analyzing the Results: Analyze the simulation results to determine the effectiveness of the recommendations in improving access to maternal health. Identify any gaps or areas for further improvement. Compare the simulated outcomes with the baseline data to quantify the impact of the recommendations.

6. Refining the Model: Based on the analysis of the simulation results, refine the simulation model to incorporate any additional factors or interventions that may further improve access to maternal health. This can involve adjusting variables, adding new variables, or modifying the model structure.

7. Repeating the Simulation: Run the refined simulation model to assess the impact of the refined recommendations. Repeat this process iteratively until the desired level of improvement in access to maternal health is achieved.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of the recommendations on improving access to maternal health and make informed decisions on implementing these interventions in real-world settings.


Statistics:
Citations: 62
Identifiers:
DOI: 10.1016/j.ijgo.2013.06.003
ISSN: 00207292
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Ghana
Study Design:
Cohort Study
Participants Gender:
Female
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