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Trop Med Int Health. 2019 May;24(5):636-646. doi: 10.1111/tmi.13220. Epub 2019 Mar 11.

Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster-randomised study in rural Tanzania.

Author information

1
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
2
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
3
Ifakara Health Institute, Dar es Salaam, Tanzania.
4
Tanzania Health Promotion Support, Dar es Salaam, Tanzania.

Abstract

in English, French

OBJECTIVES:

Reduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub-optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth.

METHODS:

In this cluster-randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in-service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference-in-differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation.

RESULTS:

The intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup.

CONCLUSIONS:

We attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.

KEYWORDS:

Tanzania; Tanzanie; cluster-randomised controlled trial; essai contrôlé randomisé en grappes; evaluation; maternal and newborn health; quality; qualité; santé maternelle et néonatale; utilisation; évaluation

PMID:
30767422
PMCID:
PMC6499631
[Available on 2020-05-01]
DOI:
10.1111/tmi.13220
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