@article{fdi:010060746,
  title = {{E}ffect of a facility-based multifaceted intervention on the quality of obstetrical care : a cluster randomized controlled trial in {M}ali and {S}enegal},
  author = {{P}irkle, {C}. {M}. and {D}umont, {A}lexandre and {T}raore, {M}. and {Z}unzunegui, {M}. {V}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {M}aternal mortality in referral hospitals in {M}ali and {S}enegal surpasses 1% of obstetrical admissions. {P}oor quality obstetrical care contributes to high maternal mortality; however, poor care is often linked to insufficient hospital resources. {O}ne promising method to improve obstetrical care is maternal death review. {W}ith a cluster randomized trial, we assessed whether an intervention, based on maternal death review, could improve obstetrical quality of care. {M}ethods: {T}he trial began with a pre-intervention year (2007), followed by two years of intervention activities and a post-intervention year. {W}e measured obstetrical quality of care in the post-intervention year using a criterion-based clinical audit ({CBCA}). {W}e 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. {T}he {CBCA} questionnaire measured 5 dimensions of care-patient history, clinical examination, laboratory examination, delivery care and postpartum monitoring. {W}e 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. {R}esults: {F}or all women, the mean percentage of care criteria met was 66.3 ({SD} 13.5). {T}here were significantly greater mean {CBCA} scores in women treated at intervention hospitals (68.2) compared to control hospitals (64.5). {A}fter adjustment, women treated at intervention sites had 5 points' greater scores than those at control sites. {T}his difference was mostly attributable to greater clinical examination and post-partum monitoring scores. {T}he 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. {C}onclusions: {P}atients treated at hospitals with maternal death review had greater {CBCA} scores suggesting that the intervention improves quality of care. {R}esults indicate that the intervention mostly improves clinical examination at admission and post-partum monitoring. {T}hey also indicate that quality of care scores can be maximized by increasing the availability of human and material resources to hospitals in the region.},
  keywords = {{M}aternal death review ; {C}riterion based clinical audit ; {Q}uality of care ; {O}bstetrics ; {W}est {A}frica ; {MALI} ; {SENEGAL}},
  booktitle = {},
  journal = {{B}mc {P}regnancy and {C}hildbirth},
  volume = {13},
  numero = {},
  pages = {24},
  ISSN = {1471-2393},
  year = {2013},
  DOI = {10.1186/1471-2393-13-24},
  URL = {https://www.documentation.ird.fr/hor/fdi:010060746},
}