Evaluation of maternal and neonatal hospital care: quality index of completeness

Silva, Ana Lúcia Andrade da; Mendes, Antônio da Cruz Gouveia; Miranda, Gabriella Morais Duarte; Sá, Domício Aurélio de; Souza, Wayner Vieira de; Lyra, Tereza Maciel

doi:10.1590/s0034-8910.2014048004605

Cited by 8 publications

(9 citation statements)

References 16 publications

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“…Therefore, it is problematic that, according to our findings, hospitals without ICU or in those with inadequate or partially adequate ICU [ 8 ] admitted a high percentage of women at obstetric risk. Previous studies have noted a limited access to hospitals with a higher level of care in the city of Belo Horizonte [ 31 ], in the state of Paraná [ 32 ] and in the public hospital system [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Adequacy of public maternal care services in Brazil

et al. 2016

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BackgroundIn Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies.MethodsNationwide cross-sectional hospital-based study “Birth in Brazil: national survey into labor and birth” conducted in 2011–2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X 2 test to detect differences in categorical variables with the level of statistical significance set at p <0.05.ResultsGlobal rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % × 24.4 % public hospitals; 40.3 % × 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU.ConclusionsThe majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.

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Section: Discussionmentioning

confidence: 99%

Adequacy of public maternal care services in Brazil

et al. 2016

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“…However, some questions regarding near miss neonatal morbidity predate the establishment of criteria and are still pending answers. Inference of the quality of neonatal care, one of the main potentialities of the concept, is based on empirical studies 5 , 6 , 8 , 11 that do not cover important aspects of service evaluation from the perspective of health teams, for example 12 13 …”

Section: Introductionmentioning

confidence: 99%

Neonatal Morbidity Near Miss in Tertiary Hospitals in a Capital of Northeast Brazil

Brasil

Vilela

França

et al. 2019

Rev. paul. pediatr.

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Objective: To characterize near miss neonatal morbidity in tertiary hospitals in a capital city of Northeast Brazil based on Health Information Systems, and to identify differences regarding indicators of near miss cases, allowing the surveillance of newborns with risk of death.Methods: A cross-sectional study carried out in hospitals with neonatal intensive care unit, whose neonatal near miss cases in 2012 were identified from a deterministic linkage between the Mortality Information System and the Live Birth Information System. The biological variables of children, variables related to maternal characteristics and indicators of near miss were calculated by type of service and hospital. Biological variables of children, variables related to maternal characteristics and near miss indicators were calculated by service type and hospital and then compared by ratio difference test, parametric and non-parametric tests for measures of central tendency.Results: Of 24,254 live births, 2,098 cases of neonatal morbidity near miss were identified, most of them concentrated in the public hospitals (89.9%). The combination of birth weight and gestational age had the largest number of cases in both segments, public (43.5%) and private (46%). Variations in neonatal near miss indicators were observed between hospitals, which suggests assistance problems.Conclusions: The concept of neonatal near miss, its applicability with data from Health Information Systems, and its indicators are a preliminary tool to monitor hospital care for newborns by signaling health services that require in-depth evaluation and investments for quality improvement.

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“…This is further compounded by the fact that in maternal death review meetings most of the patient’s records are either missing or incompletely filled [ 6 , 7 ]. Quality of obstetric care can be assessed using either outcome indicators like maternal mortality ratio, or MNM indicators or using process indicators such as the use of prophylactic antibiotics for the reduction of puerperal sepsis after caesarian section [ 1 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study

Chikadaya

Madziyire

Munjanja

2018

BMC Pregnancy Childbirth

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BackgroundMaternal ‘near miss’ can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care.MethodsA prospective descriptive study was carried out from October 1 2016 to 31 December 2016, using the WHO criteria for maternal ‘near miss’ at the two tertiary public hospitals which receive referrals of all obstetric complications in Harare city, Zimbabwe. The objective was to calculate the ratio of maternal ‘near miss’ and associated factors. All pregnant women who developed life threatening complications classified as maternal near miss using the WHO criteria were recruited and followed up for six weeks from discharge, delivery or termination of pregnancy or up to the time of death.ResultsDuring this period there were 11,871 births. One hundred and twenty three (123) women developed severe maternal outcomes, 110 were maternal ‘near miss’ morbidity and 13 were maternal deaths. The maternal ‘near miss’ ratio was 9.3 per 1000 deliveries, the mortality index (MI) was 10.6% and the maternal mortality ratio was 110 per 100,000 deliveries. The major organ dysfunction among cases with severe maternal outcomes (SMO) was cardiovascular dysfunction (76.9%). The major causes of maternal near miss were obstetric haemorrhage (31.8%), hypertensive disorders (28.2%) and complications of miscarriages (20%). The intensive care unit (ICU) admission rate was 7.3 per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission.ConclusionThe MNM ratio was comparable to that in the region. Obstetric haemorrhage was a leading cause of severe maternal morbidity though with less mortality when compared to hypertensive disorders and abortion complications. Zimbabwe should adopt maternal near miss ratio as an indicator for evaluating its maternal health services.

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Evaluation of maternal and neonatal hospital care: quality index of completeness

Cited by 8 publications

References 16 publications

Adequacy of public maternal care services in Brazil

Adequacy of public maternal care services in Brazil

Neonatal Morbidity Near Miss in Tertiary Hospitals in a Capital of Northeast Brazil

Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study

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