Improving Obstetric and Neonatal Care in Ghana using a Multidisciplinary Approach and Continuous Quality Improvement
Abstract Number: 144
Abstract Type: Original Research
Introduction: Maternal and newborn mortality remain high in Africa because disparity exists between best practices and existing healthcare. Institutions lack trained staff, evidence-based treatments, medication, equipment, blood products, prompt cesarean delivery, multidisciplinary care and systems improvement strategies (1). Maternal and infant mortality are basic health indicators that reflect the overall adequacy of a healthcare system. In 2007 Kybele and the Ghana Health Service partnered to reduce maternal and neonatal death at a large urban hospital through the development of a quality improvement model.
Methods: Systems and patient care processes were analyzed and a model was created integrating continuous assessment, implementation, advocacy and outcomes. Key interventions were grouped within personnel-based, systems-management based, and service-quality based bundles (Figure). Implementation was evaluated tri-annually using a color-coded grading system and outcome data was collected. Statistical analysis was performed with Chi-square or Fischer’s Exact test as appropriate (p<0.05).
Results: There has been a decrease in maternal death related to pre-eclampsia and hemorrhage at Ridge Regional Hospital despite an increase in patient volume (Table). Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1 to 1.1% and 14.8 to 1.9%, respectively. Still births have also been reduced by 36% since beginning the program in 2007. The maternal mortality ratio decreased from 496 maternal deaths/100,000 live births in 2007 to 328/100,000 in 2009 (p=NS).
Year Total deliveries
Maternal deaths Pre-Eclampsia Hemorrhage Still births Still births/1000
#cases deaths #cases deaths
2007 6049 30 321 10 54 8 55 9.0
2008 7465 29 581 8 99 5 40* 5.4
2009 8230 27 994 11* 319 6* 48* 5.8
Table: Delivery and mortality trends at Ridge Regional Hospital in Accra, Ghana. *P < 0.05 for 2008 or 2009 compared to 2007.
Conclusion: Maternal and newborn mortality can be reduced in low-resource settings when appropriate models for continuous quality improvement are developed and employed.
Reference: 1) Soc. Sci. Med 1994; 38(8):1091-1110.
Acknowledgements: This work was supported by grants from the International Association for the Study of Pain (IASP) and the Lacy Foundation.