Abstract
BackgroundMaternal 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.MethodsThe 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.ResultsFor 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 registrationThe QUARITE trial is registered on the Current Controlled Trials website under ISRCTN46950658
Highlights
Maternal mortality in referral hospitals in Mali and Senegal surpasses 1% of obstetrical admissions
It is recognized that significant inroads in maternal mortality cannot be made without dramatically increasing access to emergency obstetrical care (EmOC) [2]
We address the secondary objective of improving quality of care, as it is the mechanism by which the ALARM intervention is believed to reduce maternal mortality
Summary
Maternal mortality in referral hospitals in Mali and Senegal surpasses 1% of obstetrical admissions. With a cluster randomized trial, we assessed whether an intervention, based on maternal death review, could improve obstetrical quality of care. In many places, the numbers of maternal deaths occurring in health facilities providing EmOC are unacceptably high. In Mali and Senegal, over one percent of women die giving birth in referral hospitals across the region, in places where comprehensive EmOC is available [4]. Such high case fatality suggests that poor medical practice may contribute to maternal mortality, along with other factors such as long travel times and late recognition of obstetrical complications
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
