Clinical trial NCT04278612: Evaluation of the Effectiveness of a Quality Improvement Intervention
Official title: 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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Maternal and Child Health
Keywords: Quality improvement
Integrated care
Maternal health
Child health
HIV/AIDS
South Africa
Growth Monitoring
Child Growth
Nutrition
Lead sponsor: University of KwaZulu
Sponsor class: OTHER
Collaborators: name: UNICEF
name: Institute for Healthcare Improvement
First posted: 2020-02-20
Enrollment: 1438
Sex: FEMALE
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention 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
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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.

Primary outcomes:
measure: Quality of Maternal and Child Care
timeFrame: 3 months
Secondary outcomes:
measure: Quality of Child Care
timeFrame: 3 months
measure: Quality of Maternal Care
timeFrame: 3 months
Other outcomes:
Locations:
Study officials:
References:
citation: Haskins L, Chiliza J, Barker P, Connolly C, Phakathi S, Feeley A, Horwood C. Evaluation of the effectiveness of a quality improvement intervention to support integration of maternal, child and HIV care in primary health care facilities in South Africa. BMC Public Health. 2020 Mar 12;20(1):318. doi: 10.1186/s12889-020-8397-2.