Recipient of obstetric or newborn care Pregnancy and Childbirth
Conditions
Interventions
The intervention is the adoption by a healthcare facility of standards-based audits for standards of emergency obstetric and newborn care. Using the stepped wedge design each participating health care
Sponsors
Liverpool School of Tropical Medicine
Eligibility
Sex/Gender
Female
Inclusion criteria
Inclusion criteria: Clusters: 43 healthcare facilities providing emergency obstetric and newborn care within five districts in Malawi Clients: Women and their newborns who attend the study facilities for obstetric/newborn care addressed by the standard being assessed that month
Exclusion criteria
Exclusion criteria: 1. Women who did not give birth at a healthcare facility 2. Facilities not designated to provide emergency obstetric and newborn care services as basic (BEmOC) or comprehensive (CEmOC) level
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Compliance with defined standard of care aggregated for all emergency obstetric and newborn care standards audited. This will be defined as the mean across all facilities and standards, with each standard audited by each facility carrying equal weight. (Thus, at facility level the means for CEmOC facilities which audit twice as many standards will carry twice the weight of the BEmOC facilities). Standards will be weighted by the number of facilities which audit the standard). Data collected in the following months for a facility will be used for each facility: months 1 and 6 for all standards; month 3 for the standard(s) audited in the first cycle; and month 4 for the standard(s) audited in the second cycle within the facility. The primary outcome will be derived by appropriate aggregation of estimates for individual standards. | — |
Secondary
| Measure | Time frame |
|---|---|
| Compliance with defined standard of care for each of the emergency obstetric and newborn care standards audited in the study. Measurements will be made within months 1 and 3 of each audit cycle. Additionally, in facilities which audit a standard in the first audit cycle there will be a (post-intervention) assessment during month 6 for the facility, i.e. 4 months after the intervention (‘action month’) and in those which audit the standard in the second audit cycle there will be an additional (pre-intervention) assessment during month 1 for the facility, i.e. 4 months before the ‘action month’. A standard-specific tool will be used in each month of data collection at a facility to collect data for 25 clients. The data collected will be used to classify each client as having received/not received care which is compliant with the standard. | — |
Countries
Malawi
Outcome results
None listed