Independent Statistician, Solagna, Italy.
Department of Pediatrics, Tosamaganga Council Designated Hospital, Iringa, Tanzania.
J Matern Fetal Neonatal Med. 2020 Dec;33(24):4076-4082. doi: 10.1080/14767058.2019.1594768. Epub 2019 Mar 26.
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.
质量改进方法已被整合到高资源环境中的常规医疗保健中，但在低资源环境中并未实施。我们旨在报告在撒哈拉以南地区进行质量改进干预后，在孕产妇和新生儿护理方面取得的成就。在 2012 年对坦桑尼亚 Tosamaganga 医院进行首次质量评估后，确定了主要的干预领域，并实施了质量改进计划。2016 年，同一评估小组使用世界卫生组织（WHO）的医院母婴保健质量评估工具进行了第二次质量评估。同期还收集了一些医院指标。医院服务的可及性、产房和孕产妇并发症管理从不足的护理改善为基本标准的护理，同时分娩量从 2145 例增加到 2838 例，复杂分娩率（21-26%）保持基本稳定。产房、孕产妇并发症和急救护理的改善，加上直接产科病死率（产科死亡率）从 2.9%下降到 0.27%，都取得了进展。一些新生儿领域（新生儿病房、常规新生儿护理、新生儿疾病护理、监测和随访）从较差的护理改善为基本标准的护理，而其他领域（感染控制和支持性护理、急救护理、指南和规程以及审计）仅显示出有限的改善。这些变化加上围产儿死亡率从 5.8%下降到 2.9%。质量改进计划使大多数质量护理方面取得了实质性进展，同时降低了产科和围产期的死亡率。然而，整体护理质量仍处于基本标准，干预对一些领域的影响有限，需要进一步努力，以达到可接受的护理水平。
