Brenner, S. and Madhavan, S. and Nseya, C. K. and Sese, C. and Fink, G. and Shapira, G.. (2022) Competent and deficient provision of childbirth services: a descriptive observational study assessing the quality of intrapartum care in two provinces of the Democratic Republic of the Congo. BMC Health Serv Res, 22. p. 551.
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Abstract
BACKGROUND: A majority of women in the Democratic Republic of the Congo (DRC) give birth in a health facility, but maternal and newborn mortality remains high. In rural areas, the quality of facility-based delivery care is often low. This study examines clinical quality of intrapartum care in two provinces of the DRC. METHODS: We observed process and input elements of delivery care provision at 29 facilities in Kwilu and Kwango provinces. Distinguishing non-performance attributable to provider behavior vs. input constraints, we compared both providers' adherence to clinical standards ("competent care") and non-adherence to processes for which required inputs were available ("deficient care"). RESULTS: Observing a total of 69 deliveries, care was most competent for partograph use (75% cases) and hemorrhage prevention (73%), but least for postpartum monitoring (4%). Competent care was significantly associated with higher case volumes (p = .03), skilled birth attendance (p = .05), and nulliparous women (p = .02). Care was most deficient for infection prevention (62%) and timely care (49%) and associated with cases observed at hospitals and lower delivery volume. CONCLUSIONS: Low quality was commonly not a result of missing equipment or supplies but related to providers' non-adherence to standard protocols. Low case volumes and the absence of skilled attendants seemed to be main factors for sub-standard quality care. Birth assistance during labor stage 2 was the only intrapartum stage heavily affected by the unavailability of essential equipment. Future interventions should strengthen links between birth attendants' practice to clinical protocols.
Faculties and Departments: | 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Household Economics and Health Systems Research > Epidemiology and Household Economics (Fink) 06 Faculty of Business and Economics > Departement Wirtschaftswissenschaften > Professuren Wirtschaftswissenschaften > Epidemiology and Household Economics (Fink) |
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UniBasel Contributors: | Fink, Günther |
Item Type: | Article, refereed |
Article Subtype: | Research Article |
ISSN: | 1472-6963 (Electronic)1472-6963 (Linking) |
Note: | Publication type according to Uni Basel Research Database: Journal article |
Language: | English |
Related URLs: | |
Identification Number: |
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Last Modified: | 21 Dec 2022 17:04 |
Deposited On: | 21 Dec 2022 17:04 |
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