Evaluation of the Effectiveness of a Quality Improvement Intervention
- Conditions
- Maternal and Child Health
- Interventions
- Other: Quality improvement intervention to strengthen health service provision
- Registration Number
- NCT04278612
- Lead Sponsor
- University of KwaZulu
- Brief Summary
This rigorous evaluation demonstrated that implementation of a time-limited quality improvement strategy effectively improved coverage of some components of an integrated maternal and child health service in a complex health environment, but we were unable to achieve the changes needed to provide a comprehensive package of care for mothers and children.
- Detailed Description
Background: Despite policies and guidelines recommending integration of health services in South Africa, provision of maternal and child health services remains fragmented. This study evaluated a rapid, scaleable, quality improvement intervention to improve integration of maternal and child health and HIV services at a primary health level, in KwaZulu-Natal, South Africa.
Methods: A three-month intervention comprised of six quality improvement mentoring visits, learning sessions with clinic staff to share learnings, and a self-administered checklist aimed to assist health workers monitor and implement an integrated package of health services for mothers and children. The study evaluated 27 clinics in four sub-districts using a stepped-wedge design. Each sub-district received the intervention sequentially in a randomly selected order. Five waves of data collection were conducted in all participating clinics between December 2016-February 2017. A multi-level, mixed effects logistic regression was used to account for random cluster fixed time and group effects using Stata V13.1.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 1438
Women who attended the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017.
Women who did not attend the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Intervention Quality improvement intervention to strengthen health service provision Provision of comprehensive care including the following: Baby: Measure weight and length Plot on appropriate growth charts in Road to Health Card (RTHC) Discuss with mother about the growth of the baby Identification of malnutrition and appropriate management Age-appropriate nutrition counselling Immunisation Developmental screening Vitamin A supplementation Deworming HIV Care: If mother is HIV positive - * Polymerase chain reaction (PCR) test for the baby repeated at 10 weeks * Nevirapine for the baby for six weeks Mother: Cervical cancer screening Provide family planning Screening tuberculosis (TB) and sexually transmitted infections (STIs) HIV Care: * HIV positive mothers - provide ART for the mother and adherence support * HIV negative mothers- HIV test every three months while breastfeeding Control Quality improvement intervention to strengthen health service provision Routine maternal and child care service delivery
- Primary Outcome Measures
Name Time Method Quality of Maternal and Child Care 3 months Proportion of mother-baby pairs who received comprehensive care
- Secondary Outcome Measures
Name Time Method Quality of Child Care 3 months Proportion of babies who receive growth monitoring services
Quality of Maternal Care 3 months Proportion of mothers who receive feeding advice