Audit of Referral of Obstetric Emergencies in Angola: A Tool for Assessing Quality of Care
), de Campos P.A(2), Paulsson G(3), de Oliveira J(4), Bergström S(5),
(1)
(2)
(3)
(4)
(5)
Corresponding Author
Abstract
By auditing various aspects of referrals of obstetric emergencies, we wanted to study the effectiveness over time of a recently established network of peripheral birth units and two central hospitals in Luanda. 157 women referred for obstetric emergencies were studied regarding clinical outcome and process indicators like waiting time, partogramme quality and Caesarean section rate (CSR). After a change in routines at hospital admission and further partogramme education 92 referred women were compared with the former. Maternal mortality decreased from 17.8% to nil in the second. Total mean waiting time was reduced from 13.7 hours to 1.2 hours. Partogramme quality was significantly improved. CSR increased from 13 to 30%. Prolonged labour was the most common diagnosis.This study demonstrates the importance of clinic-based audit to enhance quality of care regarding referrals of patients with obstetric emergencies (Afr J Reprod Health 2009; 13[2]:75-85).
RĖSUMĖ
Vérification des orientations vers des services spécialises des cas obstétriques d’urgence en Angola – Un outil pour l’évaluation de la qualité des soins. En vérifiant les aspects divers des orientations vers les services spécialisés de cas obstétriques d’urgence, nous avons voulu étudier l’efficacité au cours d’une période d’un réseau récemment établi des unîtes de naissance peripherale et deux hôpitaux centraux à Luanda. 157 femmes qui ont été orientées vers les services spécialisés pour des cas obstétriques d’urgence ont été étudiées à l’égard des résultats cliniques et nous avons traité des indices comme la période d’attente, la qualité de la partogramme et le taux de l’opération césarience (TOC). Après une modification à l’égard des routines dans l’administration de l’hôpital et après davantage éducation du partogramme, 92 femmes qui ont été orientées vers les spécialistes ont été comparées a celles-la. La mortalité maternelle a baissé de 17.8% à zéro dans la seconde. Le temps moyen total d’attente a diminué de 13,7 heures a 1,2 hours. La qualité du partogramme s’est améliorée de manière significative. Le TOC a augmenté de 13% à 30%. Le travail prolongé a été le diagnostic commun. L’étude montre l’importance de la vérification basée sur la clinique pour mettre en valeur la qualité du soin concernant l’orientation des patientes qui ont des cas obstétriques d’urgence (Afr J Reprod Health 2009; 13[2]:75-85).
KEYWORDS: Africa, audit, obstetric emergency, quality of care, referral, waiting time
References
Maine D. Safe Motherhood Programs: Options and Issues. Centre for Population and Family Health, Colombia University, USA. 1993.
WHO/UNICEF/World Bank. Reduction of maternal mortality. A joint WHO/UNFPA/ UNICEF/World Bank Statement, WHO
Geneva, 1999.
Mant J. Process versus outcome indicators in the assessment of quality of health care. Int J Qual Health Care 2001; 13(6): 475-480.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 32(8): 1091-1110.
Crombie IK, Davies HTO, Abraham SCS, Florey C du V ( Ed). The audit handbook.
Improving health care through audit. New York: John Wiley & Sons. 1997.
Ronsmans C. What is the evidence for the role of audits to improve the quality of obstetric care. In de Brouwere V and Lerberghe W (Ed). Safe Motherhood Strategies: A Review of the Evidence. Antwerp: ITGPress, 2000, 207-227.
WHO. Preventing prolonged labour: a practical guide I-IV. Maternal health and Safe Motherhood Programme, Division of family health, WHO, Geneva, 1994.
Kowalewski M, Jahn A, Kimatta SS. Why do At-Risk Mothers Fail To Reach Referral Level? Barriers Beyond Distance and Cost. Afr J Repr Health 2000; 4(1): 100-109.
Belghiti A, De Brouwere V, Kegels G, Van Lerberghe W. Monitoring unmet obstetric need at a district level in Morocco. Trop Med Int Health 1998; 3(7): 584-591.
Martey JO, Djan JO, Twum S, Browne ENL, Opuku SA. Referrals for obstetrical complications from Ejisu district, Ghana. West Afr J Med 1998; 17(2): 58-63.
Magpie Trial Follow-Up Study Collaborative Group. The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for children at 18 months. BJOG 2007; 114(3): 289-299.
Magpie Trial Follow-Up Study Collaborative Group. The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for women at 2 years. BJOG 2007; 114(3): 300-309.
Kwast BE. Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works? Eur J Obstet Gynecol
Reprod Biol 1996;69(1):47-53
Odberg-Petterson K, Christensson K, da Gloria Gomes de Freitas E, Johansson E. Adaptation of health care seeking behaviour during childbirth: Focus group discussions with women living in the suburban areas of Luanda, Angola. Health Care Women Int 2004; 25: 255-280.
Lompo K, Hutin YJ, Traore G, Tall F, Guiard-Schmid JB, Yameogo G, Fabre-Teste B. Morbidity and mortality related to obstetrical referral patients to the hospital of Bobo-Diaoulasso, Burkina Faso. Ann Soc Belg Med Trop 1993; 73(2):153-163.
Van Coeverden de Groot AA, van
Coerverden de Groot HA, Smith CM, Isaacs S.Referrals for inadequate progress of labour from the midwife obstetric unit to the referral hospitals in Cape Town. Curationis 1994;17(4): 71-74.
Bergström S. Appropriate obstetric technologies to deal with maternal complications. In: de Brouwere V and Lerberghe W (Ed). Safe Motherhood Strategies: A Review of the Evidence. Antwerp: ITGPress. 2000, 175-194.
Sabitu K, Alti-Múazu M, Musa A, Ifenne D, Essien E, Golji N, Adidu V, Mukaddas M. The effect of improving maternity service in a secondary facility, Zaria Nigeria. Int J Gynecol Obstet 1997: S99-106.
Ifenne D, Essien E, Golji N, Sabitu K, AltiMúazu M, Musa A, Adidu V, Mukaddas V. Improving the quality of obstetric care at the teaching hospital, Zaria, Nigeria. Int J Gynecol Obstet 1997; S37-46.
Gohou V, Ronsmans C, Kacou L, Yao K, Bohoussou KM, Houphouet B, Bosso P, Diarra-Nama AJ, Bacci A, Filippi V.
Responsiveness to life-threatening obstetric emergencies in two hospitals in Abidjan, Côte d´Ivoire. Trop Med Int Health 2004; 9(3): 406-415.
Filippi V, Brugha R, Browne E, Gohou V, Bacci A, De Brouwere V, Sahel A, Gouodji S, Alikonou E, Ronsmans C. Obstetric audit in resource-poor settings: lessons from a multi-country project auditing “near miss” obstetric emergencies. Health Policy Plan 2004; 19(1): 57-66.
Graham W, Wagaarachchi P, Penney G, McCaw-Binns A, Yeboah Antwi K, Hall MH. Criteria for clinical audit and the quality of hospital-based obstetric care in developing countries. Bull World Health Org 2000; 78(5): 614-620.
Article Metrics
Abstract View
: 416 times
Download : 0 times
Refbacks
- There are currently no refbacks.
