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Int J Qual Health Care. 2016 Dec 1;28(6):682-688. doi: 10.1093/intqhc/mzw095.

Providing antenatal corticosteroids for preterm birth: a quality improvement initiative in Cambodia and the Philippines.

Author information

1
Jhpiego, Maternal and Child Survival Program (MCSP), 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC 20036, USA.
2
Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
3
Jhpiego, 1615 Thames St, Baltimore, MD 21231, USA.
4
National Maternal and Child health Center (NMCHC) of Cambodia, No 31A Rue de France (French St), Sangkat Sras Chak, Khan Daun Penh, Phnom Penh, Cambodia.
5
Human Development Research Cambodia, #6Z1, Mao Tse Toung Boulevard, Sangkat Tonle, Bassac, KhanChamkarmon, Phnom Penh 12301, Cambodia.
6
Family Health Office, Disease Prevention and Control Bureau, Department of Health, 2/F Building 14, San Lazaro Compound, Rizal Ave., Sta. Cruz, 1003, Manila.
7
Nutrition Center of the Philippines, 2332 Chino Roces Ave Ext, Taguig City, Manila, 1630 Metro Manila, Philippines.

Abstract

Objective:

To determine whether a simple quality improvement initiative consisting of a technical update and regular audit and feedback sessions will result in increased use of antenatal corticosteroids among pregnant women at risk of imminent preterm birth delivering at health facilities in the Philippines and Cambodia.

Design:

Non-randomized, observational study using a pre-/post-intervention design conducted between October 2013 and June 2014.

Setting:

A total of 12 high volume facilities providing Emergency Obstetric and Newborn Care services in Cambodia (6) and Philippines (6).

Intervention:

A technical update on preterm birth and use of antenatal corticosteroids, followed by monthly audit and feedback sessions.

Main Outcome Measure:

The proportion of women at risk of imminent preterm birth who received at least one dose of dexamethasone.

Results:

Coverage of at least one dose of dexamethasone increased from 35% at baseline to 86% at endline in Cambodia (P < 0.0001) and from 34% at baseline to 56% at endline in the Philippines (P < 0.0001), among women who had births at 24-36 weeks. In both settings baseline coverage and magnitude of improvement varied notably by facility. Availability of dexamethasone, knowledge of use and cost were not major barriers to coverage.

Conclusions:

A simple quality improvement strategy was feasible and effective in increasing use of dexamethasone in the management of preterm birth in 12 hospitals in Cambodia and Philippines.

KEYWORDS:

Cambodia; Philippines; dexamethasone; premature birth; quality improvement

PMID:
27614015
PMCID:
PMC5892161
DOI:
10.1093/intqhc/mzw095
[Indexed for MEDLINE]
Free PMC Article

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