Quality improvement collaboratives as part of a quality improvement intervention package for preterm births at sub-national level in East Africa: a multi-method analysis

Rogers Mandu; Lara Miller; Gertrude Namazzi; Nana Twum-Danso; Kevin Jacton Abidha Achola; Isabella Cooney; Elizabeth Butrick; Nicole Santos; Leakey Masavah; Alphonce Nyakech; Leah Kirumbi; Peter Waiswa; Dilys Walker

doi:10.1136/bmjoq-2023-002443

Quality improvement collaboratives as part of a quality improvement intervention package for preterm births at sub-national level in East Africa: a multi-method analysis

BMJ Open Qual. 2023 Dec 21;12(4):e002443. doi: 10.1136/bmjoq-2023-002443.

Authors

Affiliations

¹ School of Public Health, Makerere University, Kampala, Kampala, Uganda.
² Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
³ Independent Consultant, New York, New York, USA.
⁴ Kenya Medical Research Institute, Nairobi, Kenya.
⁵ Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA Elizabeth.butrick@ucsf.edu.
⁶ Karolinska Institutet, Stockholm, Stockholm, Sweden.
⁷ Department of Obstetrics and Gynecology and Global Health Sciences, University of California San Francisco Medical Center at Parnassus, San Francisco, California, USA.

Abstract

Background: Quality improvement collaboratives (QIC) are an approach to accelerate the spread and impact of evidence-based interventions across health facilities, which are found to be particularly successful when combined with other interventions such as clinical skills training. We implemented a QIC as part of a quality improvement intervention package designed to improve newborn survival in Kenya and Uganda. We use a multi-method approach to describe how a QIC was used as part of an overall improvement effort and describe specific changes measured and participant perceptions of the QIC.

Methods: We examined QIC-aggregated run charts on three shared indicators related to uptake of evidence-based practices over time and conducted key informant interviews to understand participants' perceptions of quality improvement practice. Run charts were evaluated for change from baseline medians. Interviews were analysed using framework analysis.

Results: Run charts for all indicators reflected an increase in evidence-based practices across both countries. In Uganda, pre-QIC median gestational age (GA) recording of 44% improved to 86%, while Kangaroo Mother Care (KMC) initiation went from 51% to 96% and appropriate antenatal corticosteroid (ACS) use increased from 17% to 74%. In Kenya, these indicators went from 82% to 96%, 4% to 74% and 4% to 57%, respectively. Qualitative results indicate that participants appreciated the experience of working with data, and the friendly competition of the QIC was motivating. The participants reported integration of the QIC with other interventions of the package as a benefit.

Conclusions: In a QIC that demonstrated increased evidence-based practices, QIC participants point to data use, friendly competition and package integration as the drivers of success, despite challenges common to these settings such as health worker and resource shortages.

Trial registration number: NCT03112018.

Keywords: Health services research; Implementation science; Maternal Health Services; PDSA; Paediatrics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Africa, Eastern
Child
Clinical Competence
Female
Humans
Infant, Newborn
Kangaroo-Mother Care Method*
Pregnancy
Premature Birth*
Quality Improvement

Associated data

ClinicalTrials.gov/NCT03112018