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Effectiveness of facility-based audits to improve the responsiveness of West African district hospitals to obstetric emergencies: a three-country cluster randomised controlled trial

Project information

Grant agreement ID: 32336

  • Start date

    1 January 2007

  • End date

    31 December 2011

Funded under:

FP6-INCO

  • Overall budget:

    € 2 999 979

  • EU contribution

    € 2 999 979

Coordinated by:

London School of Hygiene and Tropical Medicine

United Kingdom

Objective

Identifying and implementing sustainable interventions to improve the quality of hospital care in sub-Saharan Africa is challenging. Maternal and perinatal mortality ratios stagnate at a high level; improving hospitals' responsiveness to obstetric emergencies is thought to be an important potential contribution to decrease them. WHO will soon launch an initiative to promote a range of quality assurance strategies, including several types of facility-based audits. While audits certainly hold promise, the evidence for their effectiveness is mixed.

All randomised controlled trials of audits have been undertaken in industrialised countries, but the effectiveness of health services intervention is likely to vary according to context. We propose a cluster-randomised controlled trial in West African district hospitals to assess the effectiveness of two types of facility-based audits, criterion-based clinical audits (CBCA) and patient-centred case reviews (PCCR). WHO guidelines on the management of obstetric complications and enhanced routine documentation including the WHO pantographs will be introduced in all 36 participating hospitals, while CBCA or PCCR will be set up in 12 hospitals each.

The primary outcome variable is a responsiveness score, designed to measure technical and organisational management of obstetric emergencies. Additional outcome measures include the delay between decision and start of emergency caesarean section, and hospital based perinatal mortality. A concurrent anthropological study will improve our understanding of how audits work or why they fail and identify barriers and facilitators for their successful integration into routine practice. An economic evaluation will assess the cost-effectiveness of both interventions. We are confident that the trial results will not only provide essential data for policy making in safe motherhood, but will provide lessons for quality assurance in district hospital in developing countries in general.

Coordinator

London School of Hygiene and Tropical Medicine

Address

Keppel Street
London

United Kingdom

Participants (6)

EAST EUROPEAN INSTITUTE FOR REPRODUCTIVE HEALTH

Romania

CENTRE DE RECHERCHE EN REPRODUCTION HUMAINE ET EN DEMOGRAPHIE

Benin

MINISTERE DE LA SANTE PUBLIQUE

Niger

CHARITE - UNIVERSITATSMEDIZIN BERLIN

Germany

Centre Muraz

Burkina Faso

Prince Leopold Institute of Tropical Medicine

Belgium

Project information

Grant agreement ID: 32336

  • Start date

    1 January 2007

  • End date

    31 December 2011

Funded under:

FP6-INCO

  • Overall budget:

    € 2 999 979

  • EU contribution

    € 2 999 979

Coordinated by:

London School of Hygiene and Tropical Medicine

United Kingdom