BackgroundResearch and different organizations have proposed indicators to monitor the quality of maternal and child healthcare, such indicators are used for different purposes.ObjectiveTo perform a systematic review of indicators for the central phases of the maternal and child healthcare continuum of care (pregnancy, childbirth, newborn care and postpartum).MethodA search conducted using international repositories, national and international indicator sets, scientific articles published between 2012 and 2016, and grey literature. The eligibility criteria was documents in Spanish or English with indicators to monitor aspects of the continuum of care phases of interest.The identified indicators were characterized as follows: formula, justification, evidence level, pilot study, indicator type, phase of the continuum, intended organizational level of application, level of care, and income level of the countries. Selection was based on the characteristics associated with scientific soundness (formula, evidence level, and reliability).ResultsWe identified 1791 indicators. Three hundred forty-six were duplicated, which resulted in 1445 indicators for analysis. Only 6.7% indicators exhibited all requirements for scientific soundness. The distribution by the classifying variables is clearly uneven, with a predominance of indicators for childbirth, hospital care and facility level.ConclusionsThere is a broad choice of indicators for maternal and child healthcare. However, most indicators lack demonstrated scientific soundness and refer to particular continuum phases and levels within the healthcare system. Additional efforts are needed to identify good indicators for a comprehensive maternal and child healthcare monitoring system.Electronic supplementary materialThe online version of this article (10.1186/s12884-019-2173-2) contains supplementary material, which is available to authorized users.

Objetivo. Evaluar la calidad y cumplimiento de guías de práctica clínica (GPC) aplicables a las enfermedades crónicas no transmisibles (ECNT) en Centros de Salud (CS), y opinión del personal sobre las barreras, facilitadores y su utilización. Material y métodos. De 18 GPC valoradas con Appraisal of Guidelines Research and Evaluation II (AGREEII), se seleccionan tres para elaborar indicadores y evaluar cumplimiento usando Lot Quality Assurance Sampling (LQAS) estándar 75/95%, umbral 40/75%, respectivamente, α:0.05, β:0.10) en cinco CS. 70 profesionales fueron encuestados sobre conocimiento y utilización de GPC. Resultados. La calidad formal promedio de las GPC fue 57.2%; baja calificación en dominios:“Aplicabilidad” (<25%), “Participación de los implicados”(43.5%) y “Rigor en la elaboración” (55.0%). Su cumplimiento en CS oscila entre 39 y 53.4%. Los profesionales muestran conocimiento desigual de GPC; de 44 a 45% (según GPC)declaran que no se utilizan e identifican como principales barreras la ausencia de capacitación y su difícil accesibilidad y anejo. Conclusiones. La calidad e implantación de GPC evaluadas es deficiente, lo que constituye una oportunidad de mejora en los servicios de salud.

ObjectiveTo evaluate the quality of delivery care in maternity wards in Brazil and Mexico based on good practices (GP) and adverse events (AE), in order to identify priorities for improvement.DesignA multicentre cross-sectional study with data collection from medical records between 2015 and 2016 to compare indicators of maternal and neonatal GP and EA based on the Safe Childbirth Checklist and standardised obstetric quality indicators. Two Brazilian and five Mexican maternity wards participated in the study. Descriptive statistics and χ2 tests were performed to assess performance and significant differences between the hospitals investigated.SamplingWe analysed 720 births in Brazil and 2707 in Mexico, which were selected using a systematic random sampling of 30 medical records every fortnight for 12 2-week periods in Brazil and 18 2-week periods in Mexico. We included women and their newborns, excluding those with congenital malformations.ResultsThe Mexican hospitals showed greater adherence to GP (58.2%) and a lower incidence of AE (12.9%) than the participating institutions in Brazil (26.8% compliance with GP and 16.0% AE). In spite of these differences, the relative importance of particular quality problems and type of AE are similar in both countries. Tertiary hospitals, caring for women at higher risk, have significantly (p<0.001) higher rates of AE (27.2% in Brazil and 29.6% in Mexico) than institutions attending women at lower risk, where the frequency of AE ranges from 4.7% to 11.2%. Differences were significant (p<0.001) for most indicators of GP and AE.ConclusionData from outcome and process measures revealed similar types of failures in the quality of childbirth care in both countries and indicate the need of rationalising the use of antibiotics for the mother and episiotomy, encouraging greater adherence to partograph and to the use of magnesium sulfate for the treatment of severe preeclampsia/eclampsia.

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BackgroundThe World Health Organization (WHO) launched the “Safe Childbirth Checklist (SCC) Collaboration” in 2012. The SCC is designed to contribute to quality care by providing reminders of evidence-based practices for the prevention and management of the leading causes of maternal and neonatal morbidity and mortality. However, indicators to monitor the implementation and effectiveness of the SCC have not been defined. This study aimed to produce and pilot test a set of valid, reliable and feasible indicators to assess the implementation and effectiveness of the SCC, with an emphasis on best practices.MethodsAs part of the WHO Collaboration, the SCC was adapted to the Mexican context, and a set of indicators was developed to assess the SCC use and adherence to SCC-related best practices. The indicators were pilot tested in three hospitals for feasibility and reliability using the prevalence- and bias-adjusted kappa index (PABAK) for multiple independent evaluators (initial sample, n = 47; second sample, n = 30 to re-test reliability). The data sources were clinical records and cognitive tests drawn from questionnaires to mothers and health professionals.ResultsWe generated 53 indicators, and 38 of the indicators (those related to best practices and outcomes) were pilot tested. Of these, 26 relate to care for the mother (20 were measured based on clinical records and 6 via questionnaire), and 12 relate to newborn care (9 were medical record-based and 3 were from questionnaires). Feasible indicators were generally also reliable (PABAK≥0.6). Routine feasibility is affected by the frequency of assessed events.ConclusionsThe generated indicators allow an assessment of the implementation and effectiveness of the SCC and the monitoring of quality of care during childbirth and the immediate postpartum period.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1797-y) contains supplementary material, which is available to authorized users.