Criteria-based audit to improve a district referral system in Malawi: A pilot study

Kongnyuy, Eugene J; Mlava, Grace; Broek, Nynke van den

doi:10.1186/1472-6963-8-190

Cited by 31 publications

(31 citation statements)

References 4 publications

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“…Among the major direct causes of maternal death, postpartum hemorrhage may be the most lethal obstetric complication as women can die within a 2‐hour window or less [24,25]. Desired transfer times of 1–2 hours have been adopted by several low‐ and middle‐income countries [26,27]. Given the topography and current distribution of infrastructure in Ethiopia, we adopted 2 hours as the minimum acceptable transfer time in this context of referral between facilities.…”

Section: Methodsmentioning

confidence: 99%

Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia

Bailey

Keyes

Parker

et al. 2011

International Journal of Gynecology & Obstetrics

133

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Section: Methodsmentioning

confidence: 99%

Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia

Bailey

Keyes

Parker

et al. 2011

International Journal of Gynecology & Obstetrics

133

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“…A criteria-based audit (CBA) has been used for many years to improve clinical management in developed countries, but has just recently been introduced in developing countries. Recent CBAs in Uganda and Malawi of management of pre-eclampsia and emergency obstetrics demonstrated that it is feasible to improve the quality of obstetric care by using locally available resources [5,6]. …”

Section: Introductionmentioning

confidence: 99%

Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap

Kidanto

Wangwe

Kilewo

et al. 2012

BMC Pregnancy Childbirth

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BackgroundCriteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania.ObjectiveThe prevalence of eclampsia in MNH is high (≈6%) with the majority of cases arriving after start of convulsions. In 2004–2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania after implementation of recommendations of a previous audit.MethodsA CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH) guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit.ResultsThere was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001), urine for albumin test (61% vs. 99%; P=0.001), proper use of partogram to monitor labour (75% vs. 95%; P=0.003), treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001), Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005), full blood count (28% vs. 93%; P=0.001), serum urea and creatinine (44% vs. 86%; P=0.001), liver enzymes (4.0% vs. 86%; P=0.001), and specialist review within 2 hours of admission (25% vs. 39%; P=0.018). However, there was no significant change in terms of delivery within 24 hours of admission (69% vs. 63%; P=0.33). There was significant reduction of maternal deaths (7.7% vs. 0%; P=0.001).ConclusionCBA is applicable in low resource setting and can help to improve quality of care in obstetrics including management of pre-eclampsia and eclampsia.

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“…An integrated and comprehensive hospital/community based health program is recommended to reduce maternal and child mortality and morbidity in poor‐resources settings (World Health Organization 2005; Murray & Pearson 2006; Kongnyuy et al. 2008; Evjen‐Olsen et al.…”

Section: Introductionmentioning

confidence: 99%

Ambulance service within a comprehensive intervention for reproductive health in remote settings: a cost‐effective intervention

Somigliana

Sabino

Nkurunziza

et al. 2011

Tropical Med Int Health

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Criteria-based audit to improve a district referral system in Malawi: A pilot study

Abstract: Background: To study the feasibility of using criteria-based audit to improve a district referral system.

Cited by 31 publications

References 4 publications

Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia

Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia

Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap

Ambulance service within a comprehensive intervention for reproductive health in remote settings: a cost‐effective intervention

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