Quality Improvement Interventions for Nutritional Assessment among Pregnant Mothers in Northeastern Uganda

Abstract

Introduction Assessment of pregnant mothers for nutritional status is a neglected intervention. In Kaabong Hospital, nutritional status of pregnant mothers was not assessed during antenatal care (ANC) visits. A quality improvement (QI) project was initiated to increase nutritional assessment using midupper arm circumference (MUAC) among pregnant mothers during ANC visits from 0 to 90% between April and September 2015. Method Baylor-Uganda formed ANC Work Improvement Team (WIT) that reviewed ANC register, identified gaps in quality of care, analyzed root causes using cause-effect diagram, developed solutions, and tested and implemented the solution using Plan-Do-Study-Act cycles. Planned and tested changes included the provision of anthropometric tools, integrated ANC register, and data use. Result In April 2015 (baseline), none (0/235) of the pregnant women were assessed for nutritional status using MUAC. Following QI interventions, nutritional assessment improved to 79% (200/252) in May 2015 and to 100% (241/241) in June 2015. The 100% performance was sustained until August 2016. Overall, 39 cases of malnutrition—1 (2.6%) severe (MUAC < 19.0 cm) and 38 (97.4%) moderate acute malnutrition (MUAC 19–22.0 cm)—were identified and linked to nutritional rehabilitation program. Conclusion QI interventions are critical in achieving high rates of nutritional status assessment and identifying malnourished pregnant women during ANC visits.

Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural eastern Uganda

“…As CQI is a deliberate effort in addressing low performance, it is not surprising that rates of treatment success improved. Although publications on use of CQI in TB control programs are scarce despite existence of TB specific CQI framework [18], in HIV programs, the use of CQI has remarkably improved early infant HIV diagnosis at 6 weeks [27], nutritional assessment among pregnant mothers [28], and retention of HIV positive adolescents in care [29]. Overall, it is important to recognize that certain districts have CQI teams while others do not.…”

Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural Eastern Uganda

“…As CQI is a deliberate effort in addressing low performance, it is not surprising that rates of treatment success improved. Although publications on use of CQI in TB programs are scarce despite existence of TB specific CQI framework,(16) in HIV programs, the use of CQI has remarkably improved early infant HIV diagnosis at six weeks, (25) nutritional assessment among pregnant mothers, (26) and retention of HIV positive adolescents in care. (27) This study found that districts with high rates of treatment success commonly used Village Health We found lack of motivated and dedicated TB focal persons influenced low rates of treatment success which is in agreement with a former study where low staff motivation undermined the provision of good quality TB services in Uganda.…”

Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions

“…It is difficult to compare the success of our study to others because of the limited amount of trials of this nature. A Ugandan study showed an improvement from 0% to 79% in a 2‐month span for nutritional screenings of pregnant mothers . Again, there are few studies to compare an intervention like ours to any other, but some studies have attempted to improve calorie and protein intake in inpatient groups with varying amounts of success …”

“…A Ugandan study showed an improvement from 0% to 79% in a 2-month span for nutritional screenings of pregnant mothers. (25) Again, there are few studies to compare an intervention like ours to any other, but some studies have attempted to improve calorie and protein intake in inpatient groups with varying amounts of success. (26,27) Our study is limited by the scope of the patient population and by not having measurable caloric and protein consumption of patients.…”