scholarly journals Assessing Quality of Newborn Care at District Facilities in Malawi

2020 ◽  
Author(s):  
Kondwani Kawaza ◽  
Mai-Lei Woo Kinshella ◽  
Tamanda Hiwa ◽  
Jenala Njirammadzi ◽  
Mwai Banda ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Assessment Tool ◽  
Newborn Care ◽  
Neonatal Care ◽  
District Level ◽  
Sub Saharan Africa ◽  
Standards Of Care ◽  
District Hospitals ◽  
Care Assessment

Abstract Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care). Results: The continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0). Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

scholarly journals Assessing Quality of Newborn Care at District Facilities in Malawi

2020 ◽  
Author(s):  
Kondwani Kawaza ◽  
Mai-Lei Woo Kinshella ◽  
Tamanda Hiwa ◽  
Jenala Njirammadzi ◽  
Mwai Banda ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Assessment Tool ◽  
Newborn Care ◽  
Neonatal Care ◽  
District Level ◽  
Sub Saharan Africa ◽  
Standards Of Care ◽  
District Hospitals ◽  
Care Assessment

Abstract Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care). Results: The continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0). Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

scholarly journals Assessing Quality of Newborn Care at District Facilities in Malawi

2019 ◽  
Author(s):  
Kondwani Kawaza ◽  
Mai-Lei Woo Kinshella ◽  
Tamanda Hiwa ◽  
Jenala Njirammadzi ◽  
Mwai Banda ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Assessment Tool ◽  
Newborn Care ◽  
Neonatal Care ◽  
District Level ◽  
Sub Saharan Africa ◽  
Standards Of Care ◽  
District Hospitals ◽  
Care Assessment

Abstract Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to comprehensively assess quality of care in addition to availability and quantity of supplies and resources. Because this study focused on neonatal care, the modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017. Results: The continuum of labour, delivery and neonatal care were all assessed and areas that required improvements to meet standards of care were identified. Critical areas for improvements included the facilities for delivery, including operations and newborn care; for equipment and supplies; for neonatal case management, including sick newborns and routine monitoring and follow-up. Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed. Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

Development and Validation of a Cross-Country Hospital Patient Quality of Care Assessment Tool in Europe

2017 ◽  
Author(s):  
Amanda Villiers-Tuthill ◽  
Karolina Doulougeri ◽  
Hannah McGee ◽  
Anthony Montgomery ◽  
Efharis Panagopoulou ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Assessment Tool ◽  
Hospital Patient ◽  
Care Assessment ◽  
Cross Country ◽  
Development And Validation

scholarly journals Readiness of public health facilities to provide quality maternal and newborn care across the state of Bihar, India: a cross-sectional study of district hospitals and primary health centres

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028370 ◽  
Author(s):  
Japneet Kaur ◽  
Samuel Richard Piers Franzen ◽  
Tom Newton-Lewis ◽  
Georgina Murphy
Keyword(s):  
Quality Of Care ◽  
Quality Care ◽  
Cross Sectional Study ◽  
Neonatal Care ◽  
Cross Sectional ◽  
Equipment And Supplies ◽  
Primary Health Centres ◽  
District Hospitals ◽  
Provide Quality Care

IntroductionPoor access to quality healthcare is one of the most important reasons of high maternal and neonatal mortality in India, particularly in poorer states like Bihar. India has implemented initiatives to promote institutional maternal deliveries. It is important to ensure that health facilities are adequately equipped and staffed to provide quality care for mothers and newborns.MethodsWe conducted a cross-sectional study of 190 primary health centres (PHCs) and 36 district hospitals (DHs) across all districts in Bihar to assess the readiness of facilities to provide quality maternal and neonatal care. Infrastructure, equipment and supplies and staffing were assessed using the WHO service availability and readiness assessment and Indian public health standard guidelines. Additionally, we used household survey data to assess the quality of care reported by mothers delivering at study facilities.ResultsPHCs and DHs were found to have 61% and 67% of the mandated structural components to provide maternal and neonatal care, on average, respectively. DHs were, on average, slightly better equipped in terms of infrastructure, equipment and supplies by comparison to PHCs. DHs were found to be inadequately prepared to provide neonatal care. Lack of recommended handwashing stations and bins at both DHs and PHCs suggested low levels of hygiene. Only half of the essential drugs were available in both DHs and PHCs. While no association was revealed between structural capacity and patient-reported quality of care, adequacy of staffing was positively associated with the quality of care in DHs.ConclusionExamining all DHs and a representative sample of PHCs in Bihar, this study revealed the gaps in structural components that need to be filled to provide quality care to mothers and newborns. Access to quality care is essential if progress in reducing maternal and neonatal mortality is to be achieved in this high-burden state.

scholarly journals Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254781
Author(s):  
Manoja Kumar Das ◽  
Narendra Kumar Arora ◽  
Suresh Kumar Dalpath ◽  
Saket Kumar ◽  
Amneet P. Kumar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Newborn Care ◽  
Lessons Learned ◽  
Essential Newborn Care ◽  
Case Record ◽  
District Hospitals ◽  
Maternal And Newborn

Introduction Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts. Methods This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider’s knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact. Results The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19–42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC. Conclusion This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.

scholarly journals Quality of care for patients with Diabetes Mellitus in the More Doctors Program, in a municipality in the metropolitan region of Recife (PE), Brazil

2020 ◽  
Vol 44 (125) ◽  
pp. 384-399
Author(s):  
Maria da Penha Rodrigues dos Santos ◽  
Maria do Socorro Veloso de Albuquerque ◽  
Tereza Maciel Lyra ◽  
Antonio da Cruz Gouveia Mendes ◽  
Fabiana Letícia da Silva ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Quality Of Care ◽  
Assessment Tool ◽  
Metropolitan Region ◽  
Care Assessment ◽  
Patients With Diabetes ◽  
Primary Care Assessment Tool

RESUMO Avaliou-se a qualidade da atenção aos pacientes com diabetes nas equipes do Programa Mais Médicos. Tratou-se de um estudo quantitativo, transversal, realizado em Goiana, Pernambuco, entre novembro de 2016 e agosto de 2017. Utilizaram-se entrevistas estruturadas a partir do Primary Care Assessment Tool. Foram entrevistados 41 profissionais de Equipes de Saúde da Família ligadas ao Programa Mais Médicos e 437 usuários com Diabetes Mellitus acompanhados por essas equipes. Os achados demonstram que a presença regular dos médicos pode ter ocasionado bons resultados quanto à longitudinalidade (usuários: 7,1; profissionais: 8,2) e à utilização dos serviços (usuários: 8,5). A qualidade do componente sistema de informações (usuários: 7,6; profissionais: 9,2) indica preenchimento e disponibilidade de informações sobre pacientes. Deficiência estrutural do município pode ter contribuído para o baixo desempenho da acessibilidade (usuários: 3,6; profissionais: 3,9). Resultados insatisfatórios para orientação familiar (4,6) e comunitária (2,88), segundo usuários, reforçam a necessidade de fortalecimento desses atributos, peculiares à Estratégia Saúde da Família. Ademais, por tratar-se de um programa, existe a possibilidade de sua descontinuidade, sobretudo no cenário da Emenda Constitucional nº 95, de 2016, podendo comprometer o acesso e a continuidade dos cuidados, especialmente aos usuários com doenças crônicas que utilizam frequentemente o sistema de saúde.

scholarly journals Evaluation of the health attention to pregnant women with HIV: comparison between primary and specialized service

2019 ◽  
Vol 23 (2) ◽  
Author(s):  
Raquel Einloft Kleinubing ◽  
Daniel Gonzalo Eslava ◽  
Stela Maris de Mello Padoin ◽  
Cristiane Cardoso de Paula
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Of Care ◽  
Pregnant Women ◽  
Assessment Tool ◽  
Cross Sectional ◽  
Care Assessment ◽  
Specialized Care ◽  
Women With Hiv

ABSTRACT The public network for health care of pregnant women with HIV, in Santa Maria, Rio Grande do Sul/Brazil, includes primary and specialized care services. Objective: Evaluating whether the type of service interferes in the quality score of the health care in the experience of the pregnant women with HIV. Methods: Cross-sectional study, with data collection from April-November/2014, with 78 participants. The Primary Care Assessment Tool-Brazil instrument was applied and the Pearson's Chi-square test and Fisher's exact test were used. Results: The quality of care received was evaluated as unsatisfactory both in primary care (6.50) and in specialized care (6.35). Conclusion: The type of service interferes with the quality of care, which can affect women's choice of service. It is necessary to improve the quality of both types of services and to search for the management of shared care to attend both the usual care of gestation and the specificity of infection.

scholarly journals Context Specific Realities and Experiences of Nurses and Midwives in Basic Emergency Obstetric and Newborn Care Services in Two District Hospitals in Rwanda

2021 ◽  
Author(s):  
Aurore Nishimwe ◽  
Daphney Nozizwe Conco ◽  
Marc Nyssen ◽  
Latifat Ibisomi
Keyword(s):  
Quality Of Care ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Obstetric Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
District Hospitals ◽  
Nurses And Midwives

Abstract Background In low and middle-income countries, nurses and midwives are the frontline healthcare workers in obstetric care. Insights into the experiences of these healthcare workers in managing obstetric care emergencies are critical for improving quality of care. This article presents such insights, from the nurses and midwives working in Rwandan district hospitals, who reflected on their experiences of managing the most common birth-related complications; postpartum hemorrhage (PPH) and newborn asphyxia. This is a qualitative part of a broader research about implementation of an mLearning and mHealth decision support tool (Safe Delivery Application), in basic emergency obstetric and newborn care services in Rwanda. Methods In this exploratory qualitative aspect of the research, the first author facilitated four focus group discussions with 26 nurses and midwives from two district hospitals in Rwanda. Each focus group discussion was made up of two parts. The first part focused on the participants’ reflections on the research results, while the second part explored their experiences of delivering obstetric care services in their respective district hospitals. The research results included: survey results reflecting their knowledge and skills of PPH management and of neonatal resuscitation (NR); and findings from a six-month record review of PPH management and NR outcomes, from the district hospitals under study. Data were analyzed using hybrid thematic analysis. Results Nurses and midwives felt that the presented findings were a true reflection of the reality and offered diverse explanations for the results. The participants’ narratives of lived experiences of providing BEmONC services are presented under two broad themes: (1) self-reflections on their current practices and (2) contextual factors influencing the delivery of BEmONC services. Conclusion The insights of nurses and midwives regarding the management of birth related complications revealed multi-faceted factors that influence the quality of their obstetric care. Even though the study was focused on their management of PPH and NR, the resulting recommendations to improve quality of care could benefit the broader field of maternal and child health particularly in low and middle income countries.

scholarly journals Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chioma Oduenyi ◽  
Joya Banerjee ◽  
Oniyire Adetiloye ◽  
Barbara Rawlins ◽  
Ugo Okoli ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Family Planning ◽  
Health Services ◽  
Gender Discrimination ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Gender Based Violence ◽  
Cross Sectional ◽  
Care Assessment

Abstract Background Poor reproductive, maternal, newborn, child, and adolescent health outcomes in Nigeria can be attributed to several factors, not limited to low health service coverage, a lack of quality care, and gender inequity. Providers’ gender-discriminatory attitudes, and men’s limited positive involvement correlate with poor utilization and quality of services. We conducted a study at the beginning of a large family planning (FP) and maternal, newborn, child, and adolescent health program in Kogi and Ebonyi States of Nigeria to assess whether or not gender plays a role in access to, use of, and delivery of health services. Methods We conducted a cross-sectional, observational, baseline quality of care assessment from April–July 2016 to inform a maternal and newborn health project in health facilities in Ebonyi and Kogi States. We observed 435 antenatal care consultations and 47 births, and interviewed 138 providers about their knowledge, training, experiences, working conditions, gender-sensitive and respectful care, and workplace gender dynamics. The United States Agency for International Development’s Gender Analysis Framework was used to analyze findings. Results Sixty percent of providers disagreed that a woman could choose a family planning method without a male partner’s involvement, and 23.2% of providers disagreed that unmarried clients should use family planning. Ninety-eight percent believed men should participate in health services, yet only 10% encouraged women to bring their partners. Harmful practices were observed in 59.6% of deliveries and disrespectful or abusive practices were observed in 34.0%. No providers offered clients information, services, or referrals for gender-based violence. Sixty-seven percent reported observing or hearing of an incident of violence against clients, and 7.9% of providers experienced violence in the workplace themselves. Over 78% of providers received no training on gender, gender-based violence, or human rights in the past 3 years. Conclusion Addressing gender inequalities that limit women’s access, choice, agency, and autonomy in health services as a quality of care issue is critical to reducing poor health outcomes in Nigeria. Inherent gender discrimination in health service delivery reinforces the critical need for gender analysis, gender responsive approaches, values clarification, and capacity building for service providers.

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