Evaluation of the Effectiveness of a Quality Improvement Intervention

University of KwaZulu-Natal (UKZN)

Status: Completed

Conditions: Maternal and Child Health

Treatments: Other: Quality improvement intervention to strengthen health service provision

Study type: Interventional

Funder types: Other

Identifiers

NCT04278612

UNIP123

Details and patient eligibility

About

This rigorous evaluation demonstrated that implementation of a time-limited quality improvement strategy effectively improved coverage of some components of an integrated maternal and child health service in a complex health environment, but we were unable to achieve the changes needed to provide a comprehensive package of care for mothers and children.

Full description

Background: Despite policies and guidelines recommending integration of health services in South Africa, provision of maternal and child health services remains fragmented. This study evaluated a rapid, scaleable, quality improvement intervention to improve integration of maternal and child health and HIV services at a primary health level, in KwaZulu-Natal, South Africa.

Methods: A three-month intervention comprised of six quality improvement mentoring visits, learning sessions with clinic staff to share learnings, and a self-administered checklist aimed to assist health workers monitor and implement an integrated package of health services for mothers and children. The study evaluated 27 clinics in four sub-districts using a stepped-wedge design. Each sub-district received the intervention sequentially in a randomly selected order. Five waves of data collection were conducted in all participating clinics between December 2016-February 2017. A multi-level, mixed effects logistic regression was used to account for random cluster fixed time and group effects using Stata V13.1.

Enrollment: 1,438 patients

Sex: Female

Volunteers: No Healthy Volunteers

Inclusion criteria

Women who attended the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017.

Exclusion criteria

Women who did not attend the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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1,438 participants in 2 patient groups

Intervention

Experimental group

Description:

Provision of comprehensive care including the following: Baby: Measure weight and length Plot on appropriate growth charts in Road to Health Card (RTHC) Discuss with mother about the growth of the baby Identification of malnutrition and appropriate management Age-appropriate nutrition counselling Immunisation Developmental screening Vitamin A supplementation Deworming HIV Care: If mother is HIV positive - * Polymerase chain reaction (PCR) test for the baby repeated at 10 weeks * Nevirapine for the baby for six weeks Mother: Cervical cancer screening Provide family planning Screening tuberculosis (TB) and sexually transmitted infections (STIs) HIV Care: * HIV positive mothers - provide ART for the mother and adherence support * HIV negative mothers- HIV test every three months while breastfeeding

Treatment:

Other: Quality improvement intervention to strengthen health service provision

Control

Active Comparator group

Description:

Routine maternal and child care service delivery

Treatment:

Other: Quality improvement intervention to strengthen health service provision