Changes in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting.

Quality improvement approaches have been integrated into routine health care in high-resource settings, but not in low-resource settings. We aimed to report the achievements in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting. After a first quality assessment in 2012 at Tosamaganga hospital in Tanzania, main areas of intervention were identified and a quality improvement program was implemented. In 2016, a second quality assessment was conducted by the same assessment team by using the World Health Organization's maternal and neonatal quality of hospital care assessment tool. Some hospital indicators were also collected during the same period. Access to hospital care, maternity ward and management of maternal complications improved from inadequate to substandard care, alongside with an increment of deliveries from 2145 to 2838 and a substantially stable rate of complicated deliveries (21-26%). The improvements in the maternity ward, maternal complications and emergency care coupled with the reduction of direct obstetric case fatality rate obstetric mortality that dropped from 2.9 to 0.27%. Some neonatal areas (neonatal ward, routine neonatal care, sick newborn care, monitoring, and follow-up) improved from poor to substandard care, while others (infection control and supportive care, emergency care, guidelines protocols, and audit) showed only limited improvements. These changes coupled with a decrease in the perinatal mortality rate from 5.8 to 2.9%. The quality improvement program resulted in substantial progress in most aspects of quality care, which coupled with a decrease in obstetric and perinatal mortality. Nevertheless, the overall quality of care remained substandard with the limited effect of the intervention on some areas, which require further efforts in order to achieve an acceptable level of care.