Providing antenatal corticosteroids for preterm birth: a quality improvement initiative in Cambodia and the Philippines

Abstract

ObjectiveTo determine whether a simple quality improvement initiative consisting of a technical update and regular audit and feedback sessions will result in increased use of antenatal corticosteroids among pregnant women at risk of imminent preterm birth delivering at health facilities in the Philippines and Cambodia.DesignNon-randomized, observational study using a pre-/post-intervention design conducted between October 2013 and June 2014.SettingA total of 12 high volume facilities providing Emergency Obstetric and Newborn Care services in Cambodia (6) and Philippines (6).InterventionA technical update on preterm birth and use of antenatal corticosteroids, followed by monthly audit and feedback sessions.Main Outcome MeasureThe proportion of women at risk of imminent preterm birth who received at least one dose of dexamethasone.ResultsCoverage of at least one dose of dexamethasone increased from 35% at baseline to 86% at endline in Cambodia (P < 0.0001) and from 34% at baseline to 56% at endline in the Philippines (P < 0.0001), among women who had births at 24–36 weeks. In both settings baseline coverage and magnitude of improvement varied notably by facility. Availability of dexamethasone, knowledge of use and cost were not major barriers to coverage.ConclusionsA simple quality improvement strategy was feasible and effective in increasing use of dexamethasone in the management of preterm birth in 12 hospitals in Cambodia and Philippines.

Readiness to Provide Antenatal Corticosteroids for Threatened Preterm Birth in Public Health Facilities in Northern India

“… 36 A quality improvement initiative for ACS use comprising a technical update followed by an audit of and feedback on ACS data led to an increase in ACS coverage, knowledge score, and confidence of HCPs, as well as a complete recording of ACS data in the Philippines and Cambodia. 37 Our study identified the need for establishing a quality improvement and monitoring system for ensuring appropriate use of ACS in line with the 2015 WHO recommendations.…”

Conceptualizing and assessing improvement capability: a review

“…While some health systems and organizations have been successful at improving performance through such QI approaches [ 3 – 5 ] many are less successful. Some researchers have explored why some organizations are less able to deliver improved performance and argue that a systematic approach to developing improvement capability is required [ 6 ].…”

Factors influencing appropriate use of interventions for management of women experiencing preterm birth: A mixed-methods systematic review and narrative synthesis

“…In summary, the 46 included studies were conducted in 32 countries in Region of the Americas (6 countries: United States of America [ 24 , 40 – 51 ], Canada [ 44 , 52 – 54 ], Mexico [ 55 , 56 ], Ecuador [ 56 ], El Salvador [ 56 ], and Uruguay [ 56 ]), Western Pacific Region (7 countries: Australia [ 23 , 57 – 63 ],New Zealand [ 58 – 64 ], Vietnam [ 22 ], Singapore [ 65 ], Taiwan [ 66 , 67 ], Cambodia [ 68 ], and Philippines [ 68 ]), European Region (4 countries: United Kingdom [ 69 – 72 ], Ireland [ 73 ], Sweden [ 74 ], and France [ 75 , 76 ]), Southeast Asia Region (4 countries: Thailand [ 77 ], Bangladesh [ 22 ], India [ 22 , 78 ], and Nepal [ 22 ]), Eastern Mediterranean Region (2 countries: Afghanistan [ 22 ] and Pakistan [ 22 ]), Africa region (9 countries: Cameroon [ 22 ], Democratic Republic of Congo [ 22 , 79 ], Kenya [ 22 ], Malawi [ 22 , 79 – 81 ], Nigeria [ 22 , 79 ], Uganda [ 22 , 79 ], Ethiopia [ 79 ], Sierra Leone [ 79 ], and Tanzania [ 79...…”