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Publication Type
Report
UWI Author(s)
Author, Analytic
Burkhalter, B; Edson, W; Harvey, S; Boucar, M; Djibrina, S; Hermida, H; Ayabaca, P; Bucagu, M; Gbangbade, S; McCaw-Binns, A
Author Role
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Author Affiliation
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Section Title
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Medium Designator
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Connective Phrase
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Author, Monographic
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Author Role
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Report Title
Quality of obstetric care observed in 14 hospitals in Benin, Ecuador, Jamaica and Rwanda
Reprint Status
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Edition
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Author, Subsidiary
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Author Role
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Place of Publication
Bethesda, MD
Publisher Name
Quality Assurance Project for USAID
Date of Publication
2006
Report ID
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Extent of Work
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Series Title
Operations Research Results
Series Volume ID
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Series Issue ID
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Location/URL
http:; www.qaproject.org/pubs/PDFs/ORRSO2QCare.pdf
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Abstract
Trained clinical observers used a structured checklist at referral and district/regional hospitals in four developing countries to monitor care provided to 245 women during labor, delivery, and postpartum and their newborns during postpartum. The countries were Benin, Ecuador, Jamaica, and Rwanda. Observation periods were either continuous and lasted 72 hours or noncontinuous and lasted 12 hours over 46 days; all such periods included a weekend day and night. Observers marked the checklist to record the times when healthcare providers performed certain tasks and whether each had been done according to standard. Certain circumstance ssuch as a woman giving birth before arrival required rigorous data cleaning. The quality of care for the different tasks is reported here by country, by hospital type, and overall. The frequency of labor monitoring was well below the rates recommended in all four countries, regardless of hospital type. Fetal heart rate (FHR) was monitored the most frequently at 1.3 times per hour, although its recommended rate in all countries is twice an hour. Other labor indicators recommended at twice per hour were checked less often: maternal pulse was taken 0.43 times per hour, contraction intervals 0.38 times per hour, and contraction duration 0.37 times per hour. The two indicators recommended at the rate of once every four hours (0.25 times per hour) were performed more frequently: maternal blood pressure at 0.63 times per hour and vaginal exam at 1.1 times per hour. On average, in 26% of the cases, no labor indicator was monitored at all. In the three study countries where partograph use is recommended, incorrect use was observed in more than half the case observations, varying substantially by country. Correct partograph use was associated with more frequent labor monitoring. Performance on 17 recommended intrapartum tasks varied substantially by task and country, but generally not by hospital type. Many tasks were performed to standard in over 80%and even 90%of the cases, but a few were performed to standard infrequently: suctioning the newborn (22%), putting newborn skin-to-skin with mother (29%), and washing hands (33%). Frequencies of tasks during both mother and baby postpartum care were also low and varied widely by country, averaging once every two hours or longer in three countries and just over once per hour in the fourth, all far below the recommended standard of four or more times per hour. Performance of yes-no (as opposed to frequency) postpartum tasks also varied widely by country. For instance, the percentage of cases where the motherís temperature was taken at least once postpartum varied from 0% to 82%, depending on the country. There was low correlation between performance during labor and performance in the other three phases (intrapartum, mother postpartum, and baby postpartum), but a moderate correlation between combinations of the last three phases (about 0.50). That is, higher performance in the intrapartum, mother postpartum, and baby postpartum phases was associated with higher performance in each of the other two phases. Since the observers did not record circumstances that may foster or impede better maternal and newborn care, it would be inappropriate for this study to draw conclusions about the causes of better or worse performance. We do however extract lessons that could inform subsequent studies seeking data for quality improvement during the four phases of birth.....
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