@article {10855, title = {What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan.}, journal = {BMJ Open}, volume = {8}, year = {2018}, month = {2018 04 12}, pages = {e017696}, abstract = {

OBJECTIVES: The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region.

DESIGN: Cross-sectional study.

SETTINGS: Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan.

ASSESSMENT TOOLS: A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate).

RESULTS: Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95\% CI 1.94 to 2.06), with the exception of the {\textquoteright}inclusion of users{\textquoteright} views{\textquoteright} (mean score 0.66, 95\% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95\% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature.

CONCLUSIONS: Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff{\textquoteright}s commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation.

}, keywords = {Armenia, Checklist, Cross-Sectional Studies, Female, Georgia, Humans, Latvia, Maternal Mortality, Medical Audit, Moldova, Near Miss, Healthcare, Pregnancy, Pregnancy Complications, Quality Improvement, Uzbekistan}, issn = {2044-6055}, doi = {10.1136/bmjopen-2017-017696}, author = {Bacci, Alberta and Hodorogea, Stelian and Khachatryan, Henrik and Babojonova, Shohida and Irsa, Signe and Jansone, Maira and Dondiuc, Iurie and Matarazde, George and Lazdane, Gunta and Lazzerini, Marzia} } @article {1828, title = {Quality of maternal and neonatal care in Albania, Turkmenistan and Kazakhstan: a systematic, standard-based, participatory assessment.}, journal = {PLoS One}, volume = {6}, year = {2011}, month = {2011}, pages = {e28763}, abstract = {

BACKGROUND: Progress in maternal and neonatal mortality has been slow in many countries despite increasing access to institutional births, suggesting deficiencies in the quality of care. We carried out a systematic assessment of the quality of maternal and newborn care in three CEE/CIS countries, using an innovative approach to identify priority issues and promote action.

METHODS: A standard-based tool, covering over 400 items grouped in 13 main areas ranging from support services to case management, was used to assess a sample of ten maternity hospitals in Albania, Kazakhstan and Turkmenistan. Sources of information were visit to services, medical records, observation of cases, and interviews with staff and mothers. A score (range 0 to 3) was attributed to each item and area of care. The assessment was carried out by a multidisciplinary team of international and national professionals. Local managers and staff provided the necessary information and were involved in discussing the findings and the priority actions.

RESULTS: Quality of care was found to be substandard in all 13 areas. The lowest scores (between one and two) were obtained by: management of normal labour, delivery, obstetric complications and sick babies; infection prevention; use of guidelines and audits; monitoring and follow-up. Neonatal care as a whole scored better than obstetric care. Interviewed mothers identified lack of information, insufficient support during labour and lack of companionship as main issues. Actions to improve quality of care were identified at facility as well as at central level and framed according to main health system functions.

CONCLUSIONS: Quality of care is a key issue to improve maternal and neonatal outcomes, particularly in countries such as CEE/CIS where access to institutional births is nearly universal. Approaches that involve health professionals and managers in comprehensive, action-oriented assessments of quality of care are promising and should be further supported.

}, keywords = {Albania, Child Health Services, Female, Humans, Infant, Newborn, Kazakhstan, Maternal Health Services, Pregnancy, Quality of Health Care, Turkmenistan}, issn = {1932-6203}, doi = {10.1371/journal.pone.0028763}, author = {Tamburlini, Giorgio and Siupsinskas, Gelmius and Bacci, Alberta} }