Mali Hospital Research Articles

Epidemiological and Clinical Profile of Breast Cancer at Bamako Radiotherapy Center

Breast cancer is a major public health problem because of its incidence and mortality. Purpose: To establish the epidemiological and clinical characteristics of breast cancer seen at the radiotherapy center at the Mali Hospital of Bamako. Patients and methods: It was a retrospective, descriptive study of data from patients seen for breast cancer at the Center of Radiotherapy of Mali Hospital between April 2014 and December 2016. The parameters studied were: age, sex, family history of breast cancer, menopausal status, parity, breast tumor location, histological type, histological grade, cancer classification stage. Results: 134 cases of breast cancer were collected, with a frequency of 15%. The sex ratio (H/F) of 0.007. The patient’s mean age was 47 ± 11 years old. The most represented age groups were 33 - 47 years old with 45.5% and 48 - 62 years old with 39%. Three percent (3%) of patients had a family history of breast cancer. Fifty (50%) of the patients were menopausal. The main clinical signs found were : mammary nodules (98%), mastodynia (65%), nodes (67%). Invasive ductal carcinomas were found in 94% of patients, followed by infiltrating lobular carcinomas with 3.7% and metaplastic carcinomas with 1.7%. SBR Grades II and III were mostly found with 37% and 23%. The average tumor size was 87 mm ± 43. Stage III was predominantly represented with 72%, followed by Stage II with 24% and Stages I and IV with 2% each. Conclusion: Breast cancer is common and reaches both before and after 50 years; the diagnosis is usually late; hence it is the importance of raising awareness and screening before the age of 50 and popularizing some complementary tests to better understand the prognosis of this disease and promote more targeted and conservative treatments that will improve survival.

Initial Experience with Open Heart Surgery in Sub-Saharan Africa: Challenges in Mali with Minimum Standards for Practice

Introduction: There has been limited experience with Open Heart Surgeries (OHS) in Sub-Saharan Africa. In west Africa especially in Mali, most fledgling centers are unable to overcome the myriad of challenges encountered in establishing OHS though there is a high prevalence of surgically correctable heart diseases. The aim of this paper is to review our initial experience of our first cases in developing OHS program and discuss the challenges and prospects that need to be overcome to further develop it. Methods: A total of 6 patients who underwent OHS during the first “cardiac mission” in July 2016 were included in this retrospective study. The medical records of the patients were examined and data on age, sex, diagnosis, EuroSCORE, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted. Results: Six patients with a male to female ratio of 1, ages ranging between 12 and 35 years (mean of 22.5 ± 12 years) were studied. The mean of EuroSCORE was 6 ± 41. Pericardial patch closure of isolated atrial septal defect was performed in one patient. One patient had mitral valve repair for rheumatic mitral regurgitation consisting of chordal shortening with a tricuspid valvuloplasty. Three patients had mitral valve replacement with tricuspid valvuloplasty. Four patients had mitral valve replacement. Sixty-day mortality was 0%. Conclusion: Safe conduct of open heart surgery in Mali Hospital setting is feasible. Grant financial aid is required for rapid growth of Open-Heart Surgery in this part of Sub-Saharan Africa.

Hypertensive Heart Disease, Epidemiological, Diagnostic and Evolutionary Aspects: About 103 Cases in a Cardiology Department of Sikasso Hospital in Mali

Hypertensive Heart Disease, Epidemiological, Diagnostic and Evolutionary Aspects: About 103 Cases in a Cardiology Department of Sikasso Hospital in Mali

Non-Valvular Atrial Fibrillation: Diagnostic and Therapeutic Aspects About 45 Cases in a Cardiology Department of Sikasso Hospital in Mali

scholarly articles on cardiology Journal of Cardiology & Cardiovascular Therapy is an Open Access, international peer reviewed journal launched from Juniper Publishers. Cardiology is a branch of medicine deals with the disorders of heart that keeps cardiologists up to date with advances in the diagnosis and treatment of cardiovascular diseases.

Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data

BackgroundThe purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-Saharan African women. Uterine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. However, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly.MethodsCross-sectional data analysis from the pre-intervention period (Oct. 1, 2007- Oct. 1, 2008) of the QUARITE trial, a large-scale maternal mortality study. This research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in Mali and Senegal. A mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital.ResultsFive hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. Predictors of uterine rupture: grand multiparity defined as > 5 live births (aOR = 7.57, 95%CI; 5.19–11.03), prior cesarean (aOR = 2.02, 95%CI; 1.61–2.54), resides outside hospital region (aOR = 1.90, 95%CI: 1.28–2.81), no prenatal care visits (aOR = 1.80, 95%CI; 1.44–2.25), and birth weight of > 3600 g (aOR = 1.61, 95%CI; 1.30–1.98). Women who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (aOR: 46.25, 95%CI; 32.90–65.02).ConclusionsThe results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. Improving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture.

Can Chinese medical teams in Africa become more effective? The example of Mali

BackgroundChina has been sending medical teams to Africa since 1963. Chinese Medical Teams (CMT) are currently working in 42 African countries, constituting a large component of Chinese health aid. Mali has been receiving teams on a continuous basis since 1968. From 2011 the team in Mali has been based in the Mali Hospital in Bamako. This hospital was built with Chinese Government aid. The aim of this study was to observe how the CMT functioned, how their role was perceived, and to assess their utility for the hospital and its patients. MethodsThe study was carried out from January to March 2018. In-depth interviews were carried out with 12 Malian doctors and 12 nurses, all the members of the CMT (except support staff), as well as four key stakeholders and ten patients. Interviews explored views about the role of the Chinese team in the hospital, the pros and cons of the collaboration, and suggestions for improvement. CMT members were also asked about their motivation to work in Mali and how they managed the lifestyle. All interviews were carried out in private areas within the hospital. We recorded ethnographic observations of the hospital with a focus on relationships between Malian and Chinese staff, and general standards of care. FindingsAt the time of the study the CMT had 25 members, 18 doctors and technicians, plus support staff (cooks, translators), all living in the hospital grounds. Most of the CMT members interviewed identified similar problems, which included: lack of agreed objectives for the team members (in particular their roles as teachers or members of staff), the language barrier between Malian and Chinese staff, difficulty attracting team members, lack of representation of the CMT on the hospital management committee, and very limited social engagement between Chinese and Malian staff. However, the Malian doctors and key stakeholders viewed the CMT as a very positive presence, improving overall clinical standards and ensuring the hospital's reputation as among the best public hospitals in the country. InterpretationOur findings indicate that there needs to be a formal evaluation of the CMT programme in Mali and in other countries in Africa, to maximise utility and meet contemporary needs. This is especially relevant as the Chinese Government embarks on including global health as part of the Belt and Road initiative. FundingGlobal Health Centre of Zhejiang University.

Comparison of severe trauma treatment standards in civilian China with current practice in the Chinese military peacekeeping Level 2 Military Hospital in Gao, Mali

IntroductionThe People’s Republic of China has been successfully deploying medical teams to support the peacekeeping mission at the Level 2 Military Hospital in Mali since December 2013. The aim of...

Oral Status of Children with Diabetes in the Hospital of Mali: 79 Observations

Oral Status of Children with Diabetes in the Hospital of Mali: 79 Observations

Rubber band ligation in the management of symptomatic hemorrhoidal pathology after failure of traditional treatment at the Sikasso hospital in Mali

Rubber band ligation in the management of symptomatic hemorrhoidal pathology after failure of traditional treatment at the Sikasso hospital in Mali

Management for esophageal foreign bodies: about 36 cases

L'ingestion de corps étranger de l'œsophage est un motif fréquent de consultation aux urgences pédiatriques. Cependant le phénomène peut se retrouver à tous les âges. Les auteurs décrivent les caractéristiques cliniques, paracliniques et thérapeutiques des corps étrangers enclavés dans l'œsophage pris en charge à l'hôpital du Mali. Il s'agit d'une étude prospective, menée entre janvier 2011 et décembre 2014 incluant tous les cas d'ingestion de corps étrangers enclavés dans l'œsophage. Au total 36 patients ont été pris en charge par des moyens endoscopiques ou chirurgicaux. L'âge moyen était de 6 ans (extrêmes: 14 mois- 62 ans). Le sexe masculin était dominant avec un sexe ratio de 1,75. Les corps étrangers étaient bloqués dans le rétrécissement crico-pharyngien dans 69,45% des cas suivi du rétrécissement aortique dans 22,22% des cas. Le délai d'extraction du corps étranger en moyenne était de 7 heures 30. La fibroscopie rigide a permis l'extraction du corps étranger dans 88,89% des cas. Une chirurgie par thoracotomie a permis d'extraire le corps étranger dans 5,55%. Les corps étrangers de l'œsophage peuvent se retrouver à tout âge mais restent plus fréquent chez l'enfant. L'extraction endoscopique est la man'uvre la plus réalisée mais la chirurgie pour extraction d'un corps étranger bloqué dans l'œsophage bien que rare reste le dernier recours à cause souvent de leur nature et de la survenue des complications. Le meilleur moyen pour lutter contre ces accidents reste la prévention.

Les cellulites cervico-faciales nécrosantes d’origine dentaire dans un pays en voie de développement

Necrotizing cellulitis of dental origin is a serious disease and requires prompt and effective management to avoid adverse outcomes. The purpose of this work is to describe the diagnostic and therapeutic difficulties encountered in this condition. This was a prospective study in the thoracic surgery department of Mali Hospital from January 2011to February 2015. We collected consecutively 19cases of complicating cervico-facial cellulitis of dental origin. The anatomical and clinical aspects, therapeutic modalities and difficulties are described. Dental pain and fever were the predominant symptoms followed by cervical edema. Chest CT-scan was the basis for the diagnosis in all cases. Cervicotomy with debridement was the most performed surgical procedure. Pleural drainage was performed in 6cases. Three patients (15.8%) died. Necrotizing cellulitis of dental origin is a serious disease with high morbidity and mortality. The key radiological examination is the thoracic CT-scan. Early medico-surgical management by emergency care, tailored antibiotic therapy, removal of necrotizing tissues and drainage of collections are required to deliver a good outcome.

Pesticide Exposure And Health Risks In Mali

Introduction: Acute pesticide poisoning is a major preventable public health problem, especially in developing countries. The aim of this study is to describe the main characteristics of acute poisoning with pesticide in Mali. Methods: This is a retrospective analysis of acute pesticide poisoning cases, recorded between 2000 and 2010, in the medical records and the consultation registers at 15 hospitals in Mali. Results: There were 124 cases of acute pesticide poisoning, aged 5 days to 68 years in Mali, which was 4.1% of all poisoning cases reported during the study period. Of these, 33% were under the age of 15 years. More than 60% of the cases were males with a male-female ratio of 1.5. The average age of the patients was 22±17 years. Nearly 89% of reported cases resulted from oral exposure, 10.5% from inhalation and only 0.8% from dermal exposure. The risk was mainly related to the use of organophosphates. Pesticides were used as a means of suicide in 17.7% of cases. The poisoning symptoms were varied, depending on the characteristics of the product, duration and frequency of exposure and the delay before treatment. The average length of stay in hospital was 22 hours, with a range of 2 hours to 7 days. Among all diagnosed cases, 8.1% of them died. For other cases, the outcome was favorable with or without sequelae. Conclusions: Many situations involving pesticide exposure are linked to education and certain socio-economic conditions. These conditions tend to occur more often in developing countries. Preventive measures should be taken to rationalize pesticide use.

A national teleradiology programme in Mali: implementation and results

Summary We reviewed the national teleradiology programme in Mali to establish whether it improved diagnosis for patients and improved the referring doctor's ability to give an accurate diagnosis. The teleradiology programme connected the University Hospital in Bamako to all seven regional hospitals in Mali and one private health clinic. The pilot phase began in 2005 in three hospitals. Initially the implementation involved connections via broadband, but subsequently satellite antennae were provided at three remote hospitals in the north. Between 2005 and 2013, X-ray and mammogram images from 5628 patients were read by teleradiology. Radiologists provided the sole diagnosis for 29% of cases (i.e. the referrer did not make a diagnosis) and altered the regional doctor's diagnosis in 12% of cases. The proportion of cases for which the regional doctor gave no diagnosis decreased from 93% to 24% over the same period, indicating an increase in the doctors' confidence and incentive to test their own diagnosis. The percentage of cases for which regional doctors made an inaccurate diagnosis decreased to 3% in 2013. Use of the teleradiology service varied widely between hospitals. Successful implementation depended on local ownership of a network, which was developed in close collaboration with hospital leadership, national radiologists and other healthcare personnel.

Effect of maternal death reviews and training on maternal mortality among cesarean delivery: post-hoc analysis of a cluster-randomized controlled trial

ObjectivesTo explore the differential effect of a multifaceted intervention on hospital-based maternal mortality between patients with cesarean and vaginal delivery in low-resource settings. Study designWe reanalyzed the data from a major cluster-randomized controlled trial, QUARITE (Quality of care, Risk management and technology in obstetrics). These subgroup analyses were not pre-specified and were treated as exploratory. The intervention consisted of an initial interactive workshop and quarterly educational clinically oriented and evidence-based outreach visits focused on maternal death reviews (MDR) and best practices implementation. The trial originally recruited 191,167 patients who delivered in each of the 46 participating hospitals in Mali and Senegal, between 2007 and 2011. The primary endpoint was hospital-based maternal mortality. Subgroup-specific Odds Ratios (ORs) of maternal mortality were computed and tested for differential intervention effect using generalized linear mixed model between two subgroups (cesarean: 40,975; and vaginal delivery: 150,192). ResultsThe test for homogeneity of intervention effects on hospital-based maternal mortality among the two delivery mode subgroups was statistically significant (p-value: 0.0201). Compared to the control, the adjusted OR of maternal mortality was 0.71 (95% CI: 0.58–0.82, p=0.0034) among women with cesarean delivery. The intervention had no significant effect among women with vaginal delivery (adjusted OR 0.87, 95% CI 0.69–1.11, p=0.6213). This differential effect was particularly marked for district hospitals. ConclusionMaternal deaths reviews and on-site training on emergency obstetric care may be more effective in reducing maternal mortality among high-risk women who need a cesarean section than among low-risk women with vaginal delivery.

Antibioprophylaxy by the Surgery Staff in the Teaching Hospital Gabriel Touré in Mali

This prospective survey was conducted from February to December 2014 about the use ceftriaxone (ceftriaz) for antibioprophylaxy concerning 300 patients by the surgery staff in the Gabriel Touré Teaching Hospital in Mali. The quantity of drug used was based on the weight of the patient. One dose was administrated in intravenous at the anesthesiology induction time. For more than 2 hours of intervention time, 4 (1.3%) patients received a second dose. The majority of cases (189, 63%) were out of emergency (emergency cases—111, 37%). The mean age was 41.6 years (range: 3 - 95 years). The patients were classed Altmeir II 203 (67.7%) and Altmeir I 97 (32.3%). The NNISS score 0 concerned 101 (33.6%) and NNISS 1 in 180 (60%) patients. The factors of risky were anemia (38; 12.7%), diabetes (6; 2%), and HIV (3; 1%). The mean of intervention duration was 56.8 ± 27.5 minutes. Four cases of intervention site infection were encountered caused by Pseudomonas aeruginosa in 2 patients; Escherichia coli (1 case), and Staphylococcus aureus (1 case). Conclusion: Antibioprohylaxy is not the only way to prevent infections but it stays necessary. The respect of hygien and aseptic measures should be used to reduce the rate of intervention site infection.

PS-058 Kerosene Poisoning In Malian Children: A 11-year Retrospective Study

Background and aims Acute poisoning is a major preventable public health problem among children in developing countries. The aim of this study is to determine the epidemiological features of kerosene poisoning in Malian children. Methods This is a descriptive retrospective study of kerosene poisoning in children under the age of 6 years, recorded between 2000 and 2010 in the medical records and the consultation registers at 15 hospitals in Mali. Results There were 98 children poisoned by kerosene in Mali, accounting for 11.1% of all poisoning cases reported in children under the age of 6 years during the period of study. The average age of the patients was 1.8 ± 1.1 years. More than half of the cases (57.1%) were males with a male-female ratio of 1.3. The median delay in presentation to hospital was 3.6 h. According to the results, the poisoning symptoms were varied, depending on the ingested quantity and the delay before treatment. The average length of stay in hospital was 34 h, with a range of 1 h to 7 days. Among the cases for whom the outcome was known, 5 of them died. For other cases, the outcome was favourable with or without sequelae. Conclusions The real number of kerosene poisoning in children is probably underestimated, because of the undiagnosed and unreported cases.

Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali.

BackgroundThe aim of this study was to evaluate the impact of telehealth on 1) the diagnosis, and management in obstetrics and cardiology, 2) health care costs from patients’ perspectives, 3) attendance at health centres located in remote areas of Mali.MethodsThe impact of telehealth on health care utilization, quality, and costs was assessed using a five-point Likert-scale based questionnaire consisting of three dimensions. It was completed by health care professionals in four district hospitals. The role of telehealth on attendance at health centres was also assessed based on data collected from the consultations logs before and during the project, between project sites and control sites. Referrals specific to the activities of the research study were also evaluated using a questionnaire to measure the real share of telehealth tools in increasing attendance at project sites. Finally, the cost savings achieved was estimated using the transport and lodging costs incurred if patients were to travel to the capital city for the same tests or care.ResultsThe telehealth activities contributed to improving medical diagnoses in cardiology and obstetrics (92.6%) and the patients’ management system on site (96.2%). The attendance records at health centres increased from 8 to 35% at all project sites during the study period. Patients from project sites saved an average of 12380 XOF (CFA Francs) or 25 USD (American dollar) and a maximum of 35000 XOF or 70 USD compared to patients from neighbouring sites, who must go to the capital city to receive the same care.ConclusionWe conclude that in Mali, enhanced training in ultrasound / electrocardiography and the introduction of telehealth have improved the health system in remote areas and resulted in high levels of appropriate diagnosis and patient management in the areas of obstetrics and cardiology. Telehealth can also significantly reduce the cost to the patient.

Predicting In-Hospital Maternal Mortality in Senegal and Mali

ObjectiveWe sought to identify predictors of in-hospital maternal mortality among women attending referral hospitals in Mali and Senegal.MethodsWe conducted a cross-sectional epidemiological survey using data from a cluster randomized controlled trial (QUARITE trial) in 46 referral hospitals in Mali and Senegal, during the pre-intervention period of the trial (from October 1st 2007 to October 1st 2008). We included 89,518 women who delivered in the 46 hospitals during this period. Data were collected on women's characteristics, obstetric complications, and vital status until the hospital discharge. We developed a tree-like classification rule (classification rule) to identify patient subgroups at high risk of maternal in-hospital mortality.ResultsOur analyses confirm that patients with uterine rupture, hemorrhage or prolonged/obstructed labor, and those who have an emergency ante-partum cesarean delivery have an increased risk of in-hospital mortality, especially if they are referred from another health facility. Twenty relevant patterns, based on fourteen predictors variables, are used to predict in-hospital maternal mortality with 81.41% sensitivity (95% CI = [77.12%–87.70%]) and 81.6% specificity (95% CI = [81.16%–82.02%]).ConclusionThe proposed class association rule method will help health care professionals in referral hospitals in Mali and Senegal to identify mothers at high risk of in-hospital death, and can provide scientific evidence on which to base their decisions to manage patients delivering in their health facilities.

Controlling Healthcare-Associated Infections in the International Research Setting

Standard infection control precautions and centralized prevention/education has improved health care outcomes for patients and health care workers (HCW).1–3 In resource-limited health care settings, implementation of these practices is challenging and transmission of highly resistant organisms within health care facilities is described.4–7 High rates of needle stick injuries and 8 unsafe injection practices9 occur in clinics and hospitals where blood borne infections such as hepatitis and HIV are common; post-exposure prophylaxis is infrequently accessed.10 Alcohol gels are perceived as expensive and may be unavailable and many settings lack appropriate hand washing facilities.11 Personal protective equipment is often absent, medical equipment may be old and in disrepair. Strict standards for environmental controls are difficult to maintain and health care facilities themselves are often archaic. International recommendations are available for infection control, but programs are not consistently regulated and have few monitoring and enforcement programs. 12–14 The National Institute of Allergy and Infectious Diseases (NIAID) supports six networks conducting HIV-related clinical research. Many clinical research sites (CRS) are located outside of the US in resource-limited settings. CRS that have access to the patients and resources necessary to perform high quality research are limited and usually engage in diverse research. A single site might have studies focusing on the prevention of mother-to-child transmission of HIV, intensive pK studies involving new drugs for multiresistant organisms, and protocols testing second-line antiretroviral therapy. Standard clinical care is provided in often crowded facilities where research subjects are present for many hours. Anecdotal observations have suggested there are significant variations in infection control practices among the sites. Methods A survey of the infection control resources and practices at the CRS outside of the United States was undertaken, led by the Office of HIV/AIDS Network Coordination (HANC). Sites were asked about a formal infection control program, staff safety, respiratory hygiene and tuberculosis control, hand hygiene capabilities, injection practices and blood safety. Results 74 sites overall were offered the survey, 32 returned completed surveys. 23/32 AIDS Clinical Trials Group sites completed the survey. Infection control organization 86% of sites had an infection control policy, of these 55% were specific to the CRS. 75% of sites had an infection control officer, directly employed by the sites half the time. The sites without an infection control policy frequently did not have policies addressing the domains surveyed. Respiratory 60% of sites reported a triage system to identify participants with potential respiratory infections. Commonly the study participant was placed in a well-ventilated area and provided a mask. Less than half of respondents (45.2%) conduct protocol procedures with participants with known or suspected tuberculosis (TB) in a separate clinic area. Natural and mechanical ventilation were common methods of ensuring respiratory hygiene. N95 masks were available in the general clinic in 39% of sites (12/31). Ultraviolet (UV) lights were present in 8/29 general clinic areas and 4/13 dedicated sputum collection areas indoors. A dedicated space for sputum collection was present in 55% of the CRSs. Space for sputum collection was most commonly an area outside (~55%) or a dedicated sputum collection area inside (~45%). In the space for sputum collection, natural and mechanical ventilation was used as infection control measures. 25% of sites reported surgical masks worn by patients. Staff were provided N95 masks 50% of the time in the dedicated sputum collection area; 2/11 sites reported that N95 respirators were available. Educational material on cough hygiene was available at 40% of the respondent sites. 45% of sites had TB surveillance programs for staff members in 45% and routinely screened staff for TB infection 71% of the time Hand Hygiene All sites reported sinks with running water; most had manual soap dispensers (25/32) and paper hand towels (27/32). Hand sanitizers were available at half of the sites. Water basins filled remotely were used in some areas in 15/32 sites, bar soap in 13/32 sites, and cloth hand towels in 11/32 sites. Blood safety All sites reported a policy for management of needle stick injuries and all sites have appropriate postexposure prophylaxis for HIV. The source patient is tested for hepatitis B at 58% of sites, and hepatitis C at 39%. Post exposure protocols for hepatitis B were present in 42% of sites. A majority of sites reported a needle recapping policy (71%) and 58% used safe needle systems. Sharps containers were generally available.

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

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