Gagua Tinatin, Beglitse Dimitry, Calancae Anna, Yunusova Dilrabo, Askerov Arsen, Ibragimova Zarina, Orozalieva Asel, Tilenbaeva Nurshaim, Yusupova Shoira, Kuzmenko Oleg, Jullien Sophie, Weber Martin W
Davit Tvildiani Medical University, Tbilisi, Georgia.
Medical institute named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University, Simferopol, Russia.
J Glob Health. 2025 May 23;15:04176. doi: 10.7189/jogh.15.04176.
Maternal health care quality remains challenging in low- and middle-income countries, including Central Asia, where access to effective care is limited. While quality improvement (QI) interventions have been introduced, their impact is rarely evaluated. This study evaluates the effects of a two-year, complex QI intervention to improve maternal health services in Kyrgyzstan and Tajikistan.
We employed a pre-post intervention design to evaluate improvements in maternal health care quality in 19 hospitals across Kyrgyzstan and Tajikistan. Following an initial assessment, an action plan was developed using a WHO-standardised tool. The study implemented a multi-faceted intervention to improve maternal health. A 0-3 scoring system measured changes over time. No control group was included.
In Kyrgyzstan, significant improvements were observed in caesarean section management (mean (x̄) = 1.9-2.1, P = 0.01), maternal complications management (x̄ = 1.6-1.9, P = 0.01), postpartum haemorrhage management (x̄ = 1.8-2.1, P = 0.03), and preeclampsia management (x̄ = 1.4-1.9, P = 0.01). Changes in hospital support services (x̄ = 1.6-1.8, P = 0.68) and infection control policies (x̄ = 1.6-1.9, P = 0.32) were not statistically significant. In Tajikistan, statistically significant improvements were seen in hospital support services (x̄ = 1.4-2.0, P = 0.01), routine labour and vaginal birth care (x̄ = 1.4-2.0, P = 0.01), infection control policies (x̄ = 1.4-1.8, P = 0.03), maternal complications management (x̄ = 1.5-2.1, P = 0.02), postpartum haemorrhage (x̄ = 1.7-2.1, P = 0.04), and labour progress (x̄ = 1.2-2.1, P = 0.01). However, changes in caesarean section management (x̄ = 1.7-2.3, P = 0.09) and emergency preparedness (x̄ = 1.6-2.3, P = 0.11) did not reach statistical significance.
The WHO-guided participatory approach set benchmarks that improved labour management, obstetric care, infection control, and infrastructure. Expanding such initiatives, especially in underserved areas, is vital to sustain and scale their impact on maternal health.
在包括中亚在内的低收入和中等收入国家，孕产妇保健质量仍然面临挑战，这些地区获得有效护理的机会有限。虽然已经引入了质量改进（QI）干预措施，但其影响很少得到评估。本研究评估了一项为期两年的复杂QI干预措施对改善吉尔吉斯斯坦和塔吉克斯坦孕产妇保健服务的效果。
我们采用干预前后设计来评估吉尔吉斯斯坦和塔吉克斯坦19家医院孕产妇保健质量的改善情况。在初步评估之后，使用世界卫生组织标准化工具制定了一项行动计划。该研究实施了多方面的干预措施以改善孕产妇健康。采用0至3评分系统来衡量随时间的变化。未纳入对照组。
在吉尔吉斯斯坦，剖宫产管理（均值（x̄）=1.9 - 2.1，P = 0.01）、孕产妇并发症管理（x̄ = 1.6 - 1.9，P = 0.01）、产后出血管理（x̄ = 1.8 - 2.1，P = 0.03）和子痫前期管理（x̄ = 1.4 - 1.9，P = 0.01）有显著改善。医院支持服务（x̄ = 1.6 - 1.8，P = 0.68）和感染控制政策（x̄ = 1.6 - 1.9，P = 0.32）的变化无统计学意义。在塔吉克斯坦，医院支持服务（x̄ = 1.4 - 2.0，P = 0.01）、常规分娩和阴道分娩护理（x̄ = 1.4 - 2.0，P = 0.01）、感染控制政策（x̄ = 1.4 - 1.8，P = 0.03）、孕产妇并发症管理（x̄ = 1.5 - 2.1，P = 0.02）、产后出血（x̄ = 1.7 - 2.1，P = 0.04）和产程进展（x̄ = 1.2 - 2.1，P = 0.01）有统计学意义的改善。然而，剖宫产管理（x̄ = 1.7 - 2.3，P = 0.09）和应急准备（x̄ = 1.6 - 2.3，P = 0.11）的变化未达到统计学意义。
世界卫生组织指导的参与式方法设定了基准，改善了分娩管理、产科护理、感染控制和基础设施。扩大此类举措，特别是在服务不足的地区，对于维持和扩大其对孕产妇健康的影响至关重要。
