Implementation of WHO Standards for Improving Maternal and Newborn Care

Study Overview
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Brief Summary
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High-quality respectful care around the time of childbirth is a fundamental aspect of human rights and, according to recent global estimates, could prevent more than 100,000 maternal deaths and 1.3 million neonatal deaths annually. Despite some maternal and newborn health indicators in high-income countries being better in comparison to low-income and middle-income countries, existing evidence shows that improvements are needed in the quality of care provided to women and newborns in every country. In 2016, the World Health Organization (WHO) developed a framework and a list of Standards for improving the quality of maternal and newborn care (QMNC). The WHO Standards define a set of 318 Quality Measures, divided into three key domains - experience of care, provision of care and availability of resources - which can be used to assess the QMNC at facility level. The ongoing project, named IMAgiNE (Improving MAternal Newborn carE), includes all maternities hospitals of the FVG Region and aimed at improving the quality of maternal and neonatal health care in the region. Quality of care is assessed using two complementary perspectives (women and health workers), with two validated questionnaires including about 100 quality measures based on the WHO Standards. It provides data on both the baseline assessment and the Quality Improvement component (progresses made).

Official Title
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Implementation of WHO Standards for Improving the Quality of Maternal-neonatal Care

Conditions
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Perinatal Care

Intervention / Treatment
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* Other: Quality improvement recommendations (action plans)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For women: 1. Women who give birth at the nine maternity hospitals of the Friuli Venezia Giulia (FVG) Region, Italy For health workers 1. All health workers directly involved in maternal/neonatal care at facility level in the FVG Region (i.e. general physicians currently working in maternal or neonatal care, midwives, nurses, neonatologists, obstetrics and gynecology doctors, and medical residents ) Exclusion Criteria: For women: Age <18 years; Stillbirth or neonatal death; Psychiatric problems who may interfere with the telephone interview; Hidden pregnancy or women whose child has been adopted or placed in foster care; Refusal to participate. For health workers Refusal to participate; Prolonged absence with unavailability during the study period.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

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
Intervention Model: Single Group Assignment
Interventional Model Description: Before-after study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: WHO Standard implementation<br> | Other: Quality improvement recommendations (action plans)<br>* Developed and implemented at facility level to address key quality gaps emerging from the baseline assessment<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Maternal and Newborn Care Index evaluated by women | Evaluated by questionnaire | At hospital discharge (assessed up to day 5) | 
| Quality of Maternal and Newborn Care Index evaluated by health professionals | Evaluated by questionnaire | At hospital discharge (assessed up to day 5) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of caesarean section |  | At hospital discharge (assessed up to day 5) | 
| Frequency of episiotomy |  | At hospital discharge (assessed up to day 5) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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maternal and newborn care, quality of care, quality improvement, WHO standards