A criteria-based audit to improve early postnatal care in Jinja, Uganda

Abstract

Background: Globally, 50% of maternal deaths and 40% of neonatal deaths occur within 24 hours of birth, notably in developing countries. (Khanal et al, 2014). The provision of postnatal care in Uganda is low: only 2% of mothers are reported to have received a postnatal checkup within one hour. Objective: To assess and improve the provision of postnatal care within the first 6 hours of birth. Methods: A criteria-based audit was carried out by retrospectively evaluating 400 case records, to observe practice in the immediate postnatal period against agreed standards. Results: Findings demonstrated that standards were infrequently met, and that assessment of the mother after admission to the postnatal ward was also found to be low. Selected interventions were introduced, and a re-audit 2 months later revealed significant improvements in the delivery of postnatal care for both mothers and babies. Findings: Criteria-based audit is a feasible quality improvement strategy, and the identification of simple interventions registered remarkable improvement, which is essential for quality postnatal care within the first 6 hours of birth.

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

“…This consistency may be due to the similarity of study design, ways of measurement as healthcare providers observed only once, and the similarity of the study unit where they take data from a nurse in maternity wards. Whereas, the finding in this study was higher than the study conducted in Mekele (22.8%),17 Uganda (12%)10 and Iraq (6%) 13. This disparity could be due to differences in measurement tools (observational checklist) to determine implementation status, and the difference in study design, and study setting as they include only hospital, study period, sample size and study participants, which includes students and charts.…”

“…However, in LMICs, only 66% of mothers who delivered in health facilities receive at least one postpartum check-up from healthcare providers before discharge from the health facility 9. Likewise, the practice of immediate PNC according to immediate PNC guidelines was very low, ranging from 6% to 37.5% 10–13. Serious gaps were identified in the practices of midwives in measuring maternal vital signs, assessing uterine contraction, conducting a physical examination at discharge, routine suctioning of the airway of newborns and immediate removal of the vernix caseosa with olive oil that has been deemed unhelpful and was not per WHO/UNICEF recommendations on immediate PNC 14–16…”

Midwives’ perceptions towards the ministry of health guidelines for the provision of immediate postpartum care in rural health facilities in Uganda

“…The findings are similar to those from other studies: While considerable efforts are directed at developing and disseminating international guidelines to improve clinical management of maternal and newborn health in low-income settings, guidelines appear to rarely influence practice, and healthcare providers often do not provide evidence-based care. For instance, a facility based audit on facility based immediate postnatal care at Jinja regional referral hospital in Uganda found that the care was suboptimal and the practice guidelines were not routinely used in care provision [ 17 ]. Other studies around child birth practices also found routine implementation of the practice guidelines wanting [ 37 , 38 ].…”

“…The benefits of clinical guidelines in improving the quality of patient care and patient outcomes have been documented in several countries [ 14 – 17 ]. However, having practice guidelines may not always translate into provision of high-quality postpartum care or care based on the latest evidence.…”

Evaluation of the quality of postnatal care and mothers satisfaction at the university college hospital Ibadan, Nigeria

“…Assessment of the psychological and emotional wellbeing of the mothers was not given much attention. Kanyunyuzi et al (2017) study in Uganda revealed that assessment of the mothers after admission to the postnatal ward was found to be low.…”