RESUMEN
OBJECTIVE: To assess whether the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved care provided during hospital-based childbirth. METHODS: A quasi-experimental study with two rounds of data collection examined whether EMAS interventions improved facility-based labor and childbirth care. Direct clinical observations were conducted for 1208 deliveries across 13 hospitals in 12 districts. Primary outcome measures included implementation of standard practices to reduce the risk of complications during labor and childbirth for both women and newborns. RESULTS: Adjusted difference-in-difference analysis compared the mean difference in quality scores between EMAS intervention hospitals and comparison sites and consistently found significantly better performance in EMAS sites: 14 points higher for labor monitoring (ß-coefficient 14.1; 95% confidence interval [CI], 7.1-21.0); 38 points higher for newborn resuscitation readiness (ß-coefficient 38.1; 95% CI, 31.1-45.2); and 33 points higher for infection prevention practices (ß-coefficient 32.6; 95% CI, 28.5-36.8). CONCLUSION: EMAS approaches emphasizing facility readiness and adherence to performance standards significantly improved labor monitoring and complication prevention practices during childbirth.
Asunto(s)
Parto Obstétrico/normas , Trabajo de Parto , Servicios de Salud Materno-Infantil/normas , Evaluación de Programas y Proyectos de Salud , Adulto , Parto Obstétrico/estadística & datos numéricos , Femenino , Hospitales/estadística & datos numéricos , Humanos , Indonesia/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Mortalidad Materna , Servicios de Salud Materno-Infantil/estadística & datos numéricos , Ensayos Clínicos Controlados no Aleatorios como Asunto , Embarazo , Mejoramiento de la CalidadRESUMEN
OBJECTIVES: Case fatality rates (CFRs) are often used as the key indicator for the measurement of quality of care at hospitals. We examine the trends of obstetric CFRs and very early neonatal mortality rates at hospitals in selected districts of Indonesia after implementation of a facility-based maternal and neonatal health intervention-the Expanding Maternal and Neonatal Survival (EMAS) program. METHODS: Random-effects Poisson regression models were fitted to routine facility data collected from 101 hospitals over approximately 4 years. Predicted incidence rates from the models were used for ascertaining the changes in CFRs and very early neonatal mortality rates during the EMAS intervention period. RESULTS: The obstetric CFR from any maternal complications decreased significantly by 50% (adjusted incidence rate ratio [IRR] 0.50; 95% confidence interval [CI] 0.42-0.61) at hospitals after the implementation of the EMAS program. On average, the CFR decreased from 5.4 to 2.6 deaths per 1000 cases of obstetric complications admitted during the program period. The very early neonatal mortality rate (deaths within 24 hours of birth) decreased by 21% (IRR 0.79; 95% CI, 0.65-0.96). CONCLUSION: Our study suggests that overall obstetric case fatality and very early neonatal mortality rates-two indicators for tracking the quality of emergency obstetric care-decreased significantly at hospitals after the implementation of the EMAS intervention program in Indonesia.