Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal

BMC Pregnancy and Childbirth

Maria-Victoria Zunzunegui¹  Mamadou Traoré²  Alexandre Dumont³  Catherine M Pirkle¹ 

[1] Research Centres of the University of Montreal Hospital Complex, Hôtel Dieu, Pavillon Masson, Montréal, Québec, Canada;URFOSAME, District health centre of Commun V, Bamako, Mali;Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France

关键词: West Africa;    Obstetrics;    Quality of care;    Criterion based clinical audit;    Maternal death review;   

Others  :  1151119
DOI  :  10.1186/1471-2393-13-24

 received in 2012-07-05, accepted in 2013-01-08,  发布年份 2013

【 摘 要 】

Background

Maternal mortality in referral hospitals in Mali and Senegal surpasses 1% of obstetrical admissions. Poor quality obstetrical care contributes to high maternal mortality; however, poor care is often linked to insufficient hospital resources. One promising method to improve obstetrical care is maternal death review. With a cluster randomized trial, we assessed whether an intervention, based on maternal death review, could improve obstetrical quality of care.

Methods

The trial began with a pre-intervention year (2007), followed by two years of intervention activities and a post-intervention year. We measured obstetrical quality of care in the post-intervention year using a criterion-based clinical audit (CBCA). We collected data from 32 of the 46 trial hospitals (16 in each trial arm) and included 658 patients admitted to the maternity unit with a trial of labour. The CBCA questionnaire measured 5 dimensions of care- patient history, clinical examination, laboratory examination, delivery care and postpartum monitoring. We used adjusted mixed models to evaluate differences in CBCA scores by trial arms and examined how levels of hospital human and material resources affect quality of care differences associated with the intervention.

Results

For all women, the mean percentage of care criteria met was 66.3 (SD 13.5). There were significantly greater mean CBCA scores in women treated at intervention hospitals (68.2) compared to control hospitals (64.5). After adjustment, women treated at intervention sites had 5 points’ greater scores than those at control sites. This difference was mostly attributable to greater clinical examination and post-partum monitoring scores. The association between the intervention and quality of care was the same, irrespective of the level of resources available to a hospital; however, as resources increased, so did quality of care scores in both arms of the trial.

Trial registration

The QUARITE trial is registered on the Current Controlled Trials website under ISRCTN46950658

【 授权许可】

   
2013 Pirkle et al.; licensee BioMed Central Ltd.

【 图 表 】

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