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Using a quality improvement approach to improve maternal and neonatal care in North Kivu, Democratic Republic of Congo
Open accessAbstract
Providing quality health care services in humanitarian settings is challenging due to population displacement, lack of qualified staff and supervisory oversight, and disruption of supply chains. This study explored whether a participatory quality improvement (QI) intervention could be used in a protracted conflict setting to improve facility-based maternal and newborn care. A longitudinal quasi-experimental design was used to examine delivery of maternal and newborn care components at 12 health facilities in eastern Democratic Republic of Congo. Study facilities were split into two groups, with both groups receiving an initial "standard" intervention of clinical training. The "enhanced" intervention group then applied a QI methodology, which involved QI teams in each facility, supported by coaches, testing small changes to improve care. This paper presents findings on two of the study outcomes: delivery of active management of the third stage of labour (AMTSL) and essential newborn care (ENC). We measured AMTSL and ENC through exit interviews with post-partum women and matched partographs at baseline and endline over a 9-month period. Using generalised equation estimation models, the enhanced intervention group showed a greater rate of change than the control group for AMTSL (aOR 3.47, 95% CI: 1.17-10.23) and ENC (OR: 49.62, 95% CI: 2.79-888.28), and achieved 100% ENC completion at endline. This is one of the first studies where this QI methodology has been used in a protracted conflict setting. A method where health staff take ownership of improving care is of even greater value in a humanitarian context where external resources and support are scarce.
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Provision of eye care with tetracycline results varied across studies.
“Provision of eye care with tetracycline was assessed at the health facility level in four studies and the results varied.31 36 47 60”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [47]
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Delivering maternal and neonatal health interventions in conflict settings: a systematic review
Munyuzangabo, M., Gaffey, M. F., Khalifa, D. S., Als, D., Ataullahjan, A., Kamali, M., Jain, R. P., Meteke, S., Radhakrishnan, A., Shah, S., et al. (2021) · BMJ Global Health · doi:10.1136/bmjgh-2020-003750 · Cited by 91
A systematic review of newborn health interventions in humanitarian settings
Rodo, M., Duclos, D., DeJong, J., Akik, C., & Singh, N. S. (2022) · BMJ Global Health · doi:10.1136/bmjgh-2022-009082 · Cited by 11
Metadata
- Authors
- Hynes, M., Meehan, K., Meyers, J., Mashukano Maneno, L., & Hulland, E.
- Affiliations
- Centers for Disease Control and Prevention (US)
- International Medical Corps (US)
- Reproductive Health Manager, International Medical Corps, Goma, Democratic Republic of Congo
- Corresponding author
- Hynes, Michelle
- Venue
- Reproductive Health Matters
- Publisher
- Informa UK Limited
- Published
- 2017-11-30
- Volume
- 25
- Issue
- 51
- Pages
- 140-150
- ISSN
- 0968-8080 (ISSN-L)
- 1460-9576
- PMC
- PMC5757313
- OpenAlex
- W2773526893
- Cited by
- 27
- References
- 6
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 8 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 3 · 2018: 1
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Reproductive Health Matters (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion, public-domain)
- PubMed Central (acceptedVersion, public-domain)
- Funders
- Enhancing Learning and Research for Humanitarian Assistance
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Keywords
- quality improvement, maternal care, neonatal care, essential newborn care, humanitarian settings, protracted conflict, North Kivu, facility-based care, health professions education, participatory intervention
- MeSH terms
- Maternal-Child Health Services, Armed Conflicts, Adult, Female, Humans, Labor, Obstetric, Longitudinal Studies, Postnatal Care, Pregnancy, Relief Work, Socioeconomic Factors, Democratic Republic of the Congo, Quality Indicators, Health Care, Young Adult, Quality Improvement
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