QUARITE (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali

Abstract

Background: Maternal and perinatal mortality are major problems for which progress in subSaharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM) International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP) in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel.

A Prediction Score for Maternal Mortality in Senegal and Mali

“…13 The present prospective observational study was conducted at 46 referral hospitals (24 in Senegal and 22 in Mali). A hospital was eligible for the trial if it had functional operating rooms and performed more than 800 deliveries annually.…”

“…Therefore, a large multicenter study was conducted in Mali and Senegal during the preintervention period of a cluster randomized trial to measure in-hospital maternal mortality before implementation of a quality care improvement program 13 and assess predictors of in-hospital mortality in patients delivering at referral hospitals included in the trial. We sought to develop and validate a score that would be useful in clinical practice to identify patients at risk of maternal mortality in developing countries.…”

“…All deliveries were prospectively recorded and data quality was regularly controlled. 13 The 46 hospitals included in the trial were representative of the existing health systems in both countries. Our findings may be generalized to other countries with similar health care systems and other referral hospitals with similar populations.…”

Obstetric quality assurance to reduce maternal and fetal mortality in Kano and Kaduna State hospitals in Nigeria

“…According to statistics of the WHO [6] and USAID [7], maternal and perinatal mortality remain high in African countries [6]. Ways to improve the quality of care have been outlined by van den Broek and Graham [8], and Dumont et al [9].…”

Midwives’ Professional Satisfaction and the Quality of Obstetric Care in Developing Country

“…The study was conducted in Senegal in health facilities selected for the QUARITE trial which ran from 2007 to 2011 [23]. The study is registred on the following number: ISTCTN4690658.…”