Evaluation of the Effectiveness of a Quality Improvement Intervention

Study Overview
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Brief Summary
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This rigorous evaluation demonstrated that implementation of a time-limited quality improvement strategy effectively improved coverage of some components of an integrated maternal and child health service in a complex health environment, but we were unable to achieve the changes needed to provide a comprehensive package of care for mothers and children.

Detailed Description
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Background: Despite policies and guidelines recommending integration of health services in South Africa, provision of maternal and child health services remains fragmented. This study evaluated a rapid, scaleable, quality improvement intervention to improve integration of maternal and child health and HIV services at a primary health level, in KwaZulu-Natal, South Africa. Methods: A three-month intervention comprised of six quality improvement mentoring visits, learning sessions with clinic staff to share learnings, and a self-administered checklist aimed to assist health workers monitor and implement an integrated package of health services for mothers and children. The study evaluated 27 clinics in four sub-districts using a stepped-wedge design. Each sub-district received the intervention sequentially in a randomly selected order. Five waves of data collection were conducted in all participating clinics between December 2016-February 2017. A multi-level, mixed effects logistic regression was used to account for random cluster fixed time and group effects using Stata V13.1.

Official Title
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Evaluation of the Effectiveness of a Quality Improvement Intervention to Support Integration of Maternal, and Child and HIV Care in Primary Health Care Facilities in South Africa

Conditions
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Maternal and Child Health

Intervention / Treatment
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* Other: Quality improvement intervention to strengthen health service provision


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women who attended the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017. Exclusion Criteria: Women who did not attend the clinic for maternal and child health care services at 27 participating clinics from January 2016-February 2017.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: The study evaluated 27 clinics in four sub-districts using a stepped-wedge design. Each sub-district received the intervention sequentially in a randomly selected order. Five waves of data collection were conducted in all participating clinics
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Provision of comprehensive care including the following: Baby: Measure weight and length Plot on appropriate growth charts in Road to Health Card (RTHC) Discuss with mother about the growth of the baby Identification of malnutrition and appropriate management Age-appropriate nutrition counselling Immunisation Developmental screening Vitamin A supplementation Deworming HIV Care: If mother is HIV positive - Polymerase chain reaction (PCR) test for the baby repeated at 10 weeks Nevirapine for the baby for six weeks Mother: Cervical cancer screening Provide family planning Screening tuberculosis (TB) and sexually transmitted infections (STIs) HIV Care: HIV positive mothers - provide ART for the mother and adherence support HIV negative mothers- HIV test every three months while breastfeeding | Other: Quality improvement intervention to strengthen health service provision<br>* Quality improvement intervention comprising of regular improvement meetings based at clinics.<br>|
| Active Comparator: Control<br>Routine maternal and child care service delivery | Other: Quality improvement intervention to strengthen health service provision<br>* Quality improvement intervention comprising of regular improvement meetings based at clinics.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Maternal and Child Care | Proportion of mother-baby pairs who received comprehensive care | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Child Care | Proportion of babies who receive growth monitoring services | 3 months | 
| Quality of Maternal Care | Proportion of mothers who receive feeding advice | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Quality improvement, Integrated care, Maternal health, Child health, HIV/AIDS, South Africa, Growth Monitoring, Child Growth, Nutrition