Monitoring healthcare improvement for mothers and newborns: A quantitative review of WHO/UNICEF/UNFPA standards using Every Mother Every Newborn assessment tools

Siseho, Gloria Mutimbwa; Mathole, Thubelihle; Jackson, Debra

doi:10.3389/fped.2022.959482

Cited by 3 publications

(17 citation statements)

References 8 publications

(37 reference statements)

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“…This study is not without limitations. As mentioned by previous authors ( 15 , 22 , 23 ), WHO standards present a good direction, but the challenge remains with the absence of standard criteria for assessing quality care, particularly in low- and middle-income countries. Another limitation common with observational and facility interviews is that staff actions may have been altered due to the presence of the assessors (Hawthorn effect), although their presence in the facility over 2 weeks could potentially have minimized the Hawthorn effect.…”

Section: Discussionmentioning

confidence: 99%

“…Our study assessed the quality-of-care standards around childbirth at admission, in labor and delivery, and immediately after birth to the time of discharge through observation. The use of data collection tools tested in large studies ( 9 , 20 , 49 ) and its capacity peer-reviewed ( 15 ) for assessing quality-of-care standards around childbirth was also a strength.…”

Section: Discussionmentioning

confidence: 99%

“…We reviewed each questionnaire and matched questions in the tools with the WHO/UNICEF/UNFPA quality measures associated with the standards. A detailed description of the mapping exercise is published in our other paper ( 15 ). In summary, we matched questions/responses in the tools to each of the measures, which required warranting that all responses/questions in the tools and all measures were considered.…”

Section: Methodsmentioning

confidence: 99%

“…The EMEN tool has strong validity and reliability as it incorporates experiences from large-scale studies and robust surveys (9). Our other paper that assessed the capacity of the EMEN tool found it strong in capturing WHO/UNICEF/ UNFPA maternal and newborn quality standards (15). The collected data did not include any respondents' personal identifiers.…”

Section: Data Collectionmentioning

confidence: 99%

“…Thus, this study reports preliminary findings of the quality-of-care interventions implemented around childbirth. We assessed the quality-of-care standards around childbirth and gauged the results against the WHO/UNICEF/UNFPA quality standards, statements, and measures using the Every Mother Every Newborn assessment tool ( 15 ). Benchmarking is crucial in identifying quality gaps and opportunities to inform strategic lifesaving interventions around childbirth.…”

Section: Introductionmentioning

confidence: 99%

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Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia

Siseho

Mathole²,

Jackson³

2023

Front. Pediatr.

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BackgroundQuality of care around childbirth can reduce above half of the stillbirths and newborn deaths. Northeast Namibia’s neonatal mortality is higher than the national level. Yet, no review exists on the quality of care provided around childbirth. This paper reports on baseline assessment for implementing WHO/UNICEF/UNFPA quality measures around childbirth.MethodsA mixed-methods research design was used to assess quality of care around childbirth. To obtain good saturation and adequate women opinions, we purposively sampled the only high-volume hospital in northeast Namibia; observed 53 women at admission, of which 19 progressed to deliver on the same day/hours of data collection; and interviewed 20 staff and 100 women who were discharged after delivery. The sampled hospital accounted for half of all deliveries in that region and had a high (27/1,000) neonatal mortality rate above the national (20/1,000) level. We systematically sampled every 22nd delivery until the 259 mother–baby pair was reached. Data were collected using the Every Mother Every Newborn assessment tool, entered, and analyzed using SPSS V.27. Descriptive statistics was used, and results were summarized into tables and graphs.ResultsWe reviewed 259 mother–baby pair records. Blood pressure, pulse, and temperature measurements were done in 98% of observed women and 90% of interviewed women at discharge. Above 80% of human and essential physical resources were adequately available. Gaps were identified within the WHO/UNICEF/UNFPA quality standard 1, a quality statement on routine postpartum and postnatal newborn care (1.1c), and also within standards 4, 5, and 6 on provider–client interactions (4.1), information sharing (5.3), and companionship (6.1). Only 45% of staff received in-service training/refresher on postnatal care and breastfeeding. Most mothers were not informed about breastfeeding (52%), postpartum care and hygiene (59%), and family planning (72%). On average, 49% of newborn postnatal care interventions (1.1c) were practiced. Few mothers (0–12%) could mention any newborn danger signs.ConclusionThis is the first study in Namibia to assess WHO/UNICEF/UNFPA quality-of-care measures around childbirth. Measurement of provider–client interactions and information sharing revealed significant deficiencies in this aspect of care that negatively affected the client’s experience of care. To achieve reductions in neonatal death, improved training in communication skills to educate clients is likely to have a major positive and relatively low-cost impact.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia

Siseho

Mathole²,

Jackson³

2023

Front. Pediatr.

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Barriers and Facilitators Influencing Midwives’ Implementation of South Africa’s Maternal Care Guidelines in Postnatal Health: A Scoping Review

Okeke

Ngunyulu

2023

Preprint

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Introduction: The implementation of South Africa’s maternal care guidelines is still subpar, especially during the postnatal periods, despite midwives’ playing a key part in postnatal care for women and their newborns. This article aimed to pinpoint the obstacles to and enablers of midwives’ roles in putting South Africa’s maternal care recommendations for postnatal health into practice.Method The methodology for this review was a scoping review. A systematic search of literature from The University of Johannesburg database, Medline, PsycINFO, Nursing and Allied Health (CINAHL plus), PubMed, EBSCOhost web, and Google Scholar on the roles of midwives in putting South Africa’s maternal care guidelines for postnatal health into practice was done. The databases produced 22 papers that met the requirements for inclusion.Results There is a gap between inadequate postnatal care services provision and suboptimal implementation of maternal recommendations. These results from a lack of basic knowledge about the guidelines, an absence of midwives in the maternity units, inadequate facilities and resources, a lack of drive and support, inadequate training of midwives in critical competencies, and poor information sharing and communication. Maintaining qualified midwives in the maternity units and providing them with training to increase their capacity, knowledge, and competencies on the guidelines’ critical information for managing postnatal complications and providing high-quality care to women and their babies are necessary to effectively implement the recommendations.Conclusion To increase patient access to good-quality care and enhance postnatal policy implementation, it is urgent to support research in the field of midwifery, particularly in the delivery of postnatal care using South Africa’s maternal care guidelines.

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Implementing quality-of-care during labour, childbirth, and early postnatal care, northeast Namibia: a quasi-experimental study

Siseho,

Mathole,

Jackson

2023

Journal of Global Health Reports

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Background Attention to quality-of-care is increasing in low- and-middle-income countries. Nevertheless, few studies exist on the impact of these approaches to caregiving. This paper presents results on the quality-of-care mothers and neonates receive during labour, childbirth, and early postnatal care, pre-and-post-implementation of the World Health Organization/United Nations Children’s Fund/United Population Fund (WHO/UNICEF/UNFPA) quality improvement interventions. Methods A quasi-experimental study design was used to assess the quality-of-care measures/interventions around childbirth and the immediate postnatal care period; we purposively sampled a high-volume hospital, northeast Namibia. Using the Every Mother Every Newborn (EMEN) childbirth quantitative survey questionnaire, we interviewed (pre=100; post=102) women who delivered prior to their discharge home and observed (pre=53; post=60) different women at admission, of which 19 of 53 and 50 of 60, respectively, progressed to deliver on the same day of data collection. Twenty (pre) and 24 (post) staff, and one facility manager (pre-and-post) were also interviewed. Descriptive statistics were used to present results. Results Postintervention, we found improvements in most assessed quality-of-care measures/interventions, e.g., thorough drying (94.7-100%), babies placed skin-to-skin with their mothers (89.5-98%) and assessed for resuscitation (69.8-98%) needs. Monitoring labour using partograph remained low (11.3-19.3%). During admission, women’s history taking (75.5-95%), blood pressure (98.1%-100%), urine testing (77.4-93.3%), foetal heart rate (94.3-100%), abdominal (86.8-100%) and vaginal examinations (96.2-100%) all improved. Yet, quality-of-care gaps were identified for labour monitoring, and routine postnatal care. Less 50% of women received counselling on family planning (5.3-42%), postnatal care (5.3-40%), maternal (0-38%) and newborn (0-40%) danger signs. Women’s satisfaction with information on breastfeeding and post-partum care and hygiene was 48-56.9% and 41-43.0% respectively. Conclusions This is the first study in Namibia to assess pre-and-post implementation of quality-of-care practices around childbirth, and postnatal period. Inconsistency and noteworthy quality-of-care gaps exist in the early postnatal care period. Postnatal care management and interpersonal communication skills trainings are likely to improve and sustain high evidence-based care beyond labour and delivery. The poor quality-of-care practices for labour and postnatal care requires further investigation.

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Monitoring healthcare improvement for mothers and newborns: A quantitative review of WHO/UNICEF/UNFPA standards using Every Mother Every Newborn assessment tools

Cited by 3 publications

References 8 publications

Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia

Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia

Barriers and Facilitators Influencing Midwives’ Implementation of South Africa’s Maternal Care Guidelines in Postnatal Health: A Scoping Review

Implementing quality-of-care during labour, childbirth, and early postnatal care, northeast Namibia: a quasi-experimental study

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