Abstract
ObjectiveTo assess and compare the quality of intrapartum and immediate postpartum care across levels of healthcare in Burkina Faso and Côte d’Ivoire using validated process indicators.DesignHealth facility-based cross-sectional study with direct observation of healthcare workers’ practices while caring for mother–newborn pairs during intrapartum and immediate postpartum periods.SettingPrimary healthcare facilities and their corresponding referral hospitals in the Central-North region in Burkina Faso and the Agneby-Tiassa-Mé region in Côte d’Ivoire.ParticipantsHealthcare providers who care for mother–newborn pairs during intrapartum and immediate postpartum periods, the labouring women and their newborns after childbirth.Main outcome measure(s)Adherence to essential best practices (EBPs) at four pause points in each birth event and the overall quality score based on the level of adherence to the set of EBPs observed for a selected pause point.ResultsA total of 532 and 627 labouring women were included in Burkina Faso and Côte d’Ivoire, respectively. Overall, the compliance with EBPs was insufficient at all the four pause points, even though it varied widely from one EBP to another. The adherence was very low with respect to hand hygiene practices: the care provider wore sterile gloves for vaginal examination in only 7.96% cases (95% CI 5.66% to 11.06%) in Burkina Faso and the care provider washed hands before examination in 6.71% cases (95% CI 3.94% to 11.20%) in Côte d’Ivoire. The adherence was very high with respect to thermal management of newborns in both countries (>90%). The overall mean quality scores were consistently higher in referral hospitals in Burkina Faso at all pause points excluding immediate post partum.ConclusionsWomen delivering in healthcare facilities do not always receive proven EBPs needed to prevent poor childbirth outcomes. There is a need for quality improvement interventions.
Highlights
Once included in the observation, a woman and thereafter her newborn were observed through the subsequent pause points unless they were referred to another health facility or transferred to a different service
Another reason why a mother–newborn pair could not be observed at the fourth pause-point was them still being in the health facility at the time the data collectors had completed their overall stay in that particular facility
The number of birth events observed by pause point by country and by health facility type are presented in table 2
Summary
Reducing the high burden of preventable maternal and neonatal deaths remains an Strengths and limitations of this study►► Random selection of health facilities in two different countries and observation of sufficient sample sizes of birth events in each country.►► Direct and prospective assessment of healthcare workers’ adherence to essential best practices (EBPs) during and after childbirth by trained healthcare providers as opposed to retrospective ascertainment through medical records in many previous studies.►► Use of context-s pecific validated EBPs to maximise relevance of the study findings.►► Each country data are not representative of the whole country.►► Because of the direct observation of the practices, we cannot rule out the Hawthorne effect and the data were collected by eight data collectors in each country and are subject to an inter-rater reliability bias even though they were trained to standardise the processes.important health-related goal in the sustainable development era. Tremendous progress has been achieved globally in this area during the last two decades, most of the highly affected countries have failed to meet the target of reducing their 1990 maternal mortality ratios by 75% by 2015.1 2 Around 830 women are still dying every day from pregnancy and childbirth-related complications, of which 99% are occurring in low-income and middle-income countries and more than 50% in sub-Saharan Africa (SSA).[1 3] There is strong evidence showing that the largest burden of maternal death is clustered around the time of childbirth and immediate postpartum period.[4] A global advocacy for skilled attendance at each birth, aiming to reduce preventable maternal deaths during the Millennium Development Goals era,[5 6] resulted in a significant increase. A skilled birth attendant and health facility delivery will improve maternal and newborn outcomes only if they encompass the implementation of proven effective interventions needed to prevent or manage major causes of maternal and newborn morbidity and mortality
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