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. Issue 5 (11th March 2019)

• Record Type: Journal Article
• Authors: Larson, Elysia; Gage, Anna D.; Mbaruku, Godfrey M.; Mbatia, Redempta; Haneuse, Sebastien; Kruk, Margaret E.
• Is Part Of: Tropical medicine & international health. Volume 24:Issue 5(2019)
• Page Start: 636
• Page End: 646
• Publication Date: 2019-03-11
• Subjects: maternal and newborn health -- quality -- utilisation -- Tanzania -- cluster‐randomised controlled trial -- evaluation; santé maternelle et néonatale -- qualité -- utilisation -- Tanzanie -- essai contrôlé randomisé en grappes -- évaluation; Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.13220
• Languages: English
• ISSNs: 1360-2276

Abstract

Abstract: 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.