Abstract
BackgroundAbout 5.8 million maternal deaths, neonatal deaths and stillbirths occur every year with 99% of them taking place in low- and middle-income countries. Two thirds of them could be prevented through cost-effective interventions during pregnancy, intrapartum and postpartum periods. Despite the availability of standards and guidelines for the care of mother and newborn, challenges remain in translating these standards into practice in health facilities. Although several quality improvement (QI) interventions have been systematically reviewed by the Cochrane Effective Practice and Organization of Care (EPOC) group, evidence lack on QI interventions for improving perinatal outcomes in health facilities. This systematic review will identify QI interventions implemented for maternal and neonatal care in health facilities and their impact on perinatal outcomes.Methods/designThis review will look at studies of mothers, newborn and both who received inpatient care at health facilities. QI interventions targeted at health system level (macro), at healthcare organization (meso) and at health workers practice (micro) will be reviewed. Mortality of mothers and newborn and relevant health worker practices will be assessed. The MEDLINE, Embase, World Health Organization Global Health Library, Cochrane Library and trial registries electronic databases will be searched for relevant studies from the year 2000 onwards. Data will be extracted from the identified relevant literature using Epi review software. Risk of bias will be assessed in the studies using the Cochrane risk of bias tool for randomized and observational studies. Standard data synthesis and analysis will be used for the review, and the data will be analysed using EPPI Reviewer 4.DiscussionThis review will inform the global agenda for evidence-based health care by (1) providing a basis for operational guidelines for implementing clinical standards of perinatal care, (2) identify research priorities for generating evidence for QI interventions and (3) QI intervention options with lessons learnt for implementation based on the level of needed resources.Systematic review registrationPROSPERO registration number CRD42018106075
Highlights
About 5.8 million maternal deaths, neonatal deaths and stillbirths occur every year with 99% of them taking place in low- and middle-income countries
This review will inform the global agenda for evidence-based health care by (1) providing a basis for operational guidelines for implementing clinical standards of perinatal care, (2) identify research priorities for generating evidence for quality improvement (QI) interventions and (3) QI intervention options with lessons learnt for implementation based on the level of needed resources
Despite the call through the Every Newborn Action Plan (ENAP) and World Health Organization (WHO)’s Ending Preventable Maternal Mortality Strategy (2015) to invest more in improving quality of care, poor health worker performance continues to compromise the care of mothers and newborn [13, 14]
Summary
It will identify evidence on QI interventions implemented to improve the care of mothers and newborn in health facilities and provide further evidence on the impact of QI interventions on quality of care. The evidence on the impact on care on maternal and neonatal care will enable an implementation framework on quality improvement to be developed. The evidence of the impact of QI interventions on improving care will provide guidance to governments and other stakeholders on the resources needed to implement QI interventions for the more effective care of mothers and babies. This systematic review will be an evidence-based reference document for WHO, UNICEF and other global health care partners to develop implementation guideline. SSB, RG, AKS, JT and HZ provided input to produce this protocol and agreed to this final version.
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