249938 Quality of care for maternal and newborn health services in sub-Saharan Africa: Results of a multi-country observational facility survey

Tuesday, November 1, 2011

Barbara J. Rawlins, MPH , Jhpiego, Johns Hopkins University, Washington, DC
Heather Rosen, MPP , Institute for International Programs, Johns Hopkins University School of Public Health, Washington, DC
Background: Meeting millennium development goals 4 and 5 will require not only increased coverage of maternal and newborn health (MNH) services in developing countries but improvement of their quality. Observational studies give the most accurate assessment of the quality of clinical practices.

Methods: The Maternal and Child Health Integrated Program (MCHIP) conducted cross-sectional national facility surveys in five countries -- Kenya, Ethiopia, Madagascar, Rwanda, Tanzania -- using mobile phones to measure the quality of antenatal and delivery care. Data collection included: structured clinical observations (over 4000 antenatal consultations and births); audit of facility infrastructure supplies and equipment; health provider interviews/knowledge tests (over 900); key informant interviews; and record review.

Results: Provision of active management of third stage of labor ranged from 10-60% of births observed. Oxytocin was available in 80% of facilities on average (range 65-87%). Although blood pressure was measured in 81-98% of ANC consultations and 71-85% of labor ward admissions observed, history taking and counseling for pre-eclampsia danger signs were performed for only 30-47% and 8-49% of clients, respectively. Essential newborn care was provided for 17-46% of newborns. Use of mobile phones for data collection, wireless data transmission, automated data analysis, and web-based presentation of data expedited study completion.

Implications: Findings from the study are available to Ministries of Health in the survey countries to inform MNH program planning and policy formulation. MCHIP is advocating for quality of care improvements based on study recommendations. Use of mobile technology can help make observational studies practical on a large scale.

Learning Areas:
Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Public health or related research

Learning Objectives:
1. Describe the advantages and challenges of conducting observational quality of care assessments using mobile technology 2. Discuss the survey findings from five countries, including facility practices for prevention of postpartum hemorrhage, screening for pre-eclampsia, and essential newborn care and resuscitation 3. Explain the implications of the study for improving quality of care in the survey countries and conducting future observational studies using mobile technology

Keywords: Maternal and Child Health, Evidence Based Practice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a sub-investigator on the study being presented
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.