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Research article
Kondwani Kawaza
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9432-4916
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district level facilities where most deliveries occur is warranted.
Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to comprehensively assess quality of care in addition to availability and quantity of supplies and resources. Because this study focused on neonatal care, the modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017.
Results: The continuum of labour, delivery and neonatal care were all assessed and areas that required improvements to meet standards of care were identified. Critical areas for improvements included the facilities for delivery, including operations and newborn care; for equipment and supplies; for neonatal case management, including sick newborns and routine monitoring and follow-up. Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed.
Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.
Keywords
district hospitals, quality of care, Malawi, neonatal care
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CURRENT STATUS: Published
View the published article at BMC Health Services Research.
No community comments so far
Editorial decision: Accept
On 02 Mar, 2020
Editor assigned
On 28 Feb, 2020
Submission checks complete
On 27 Feb, 2020
Editor invited
On 27 Feb, 2020
No comments provided
Review #2 received
Received 30 Jan, 2020
Editorial decision: Minor revision
On 30 Jan, 2020
Reviewer #2 agreed
On 20 Jan, 2020
Review #1 received
Received 20 Jan, 2020
Reviewers invited
Invitations sent on 14 Jan, 2020
Reviewer #1 agreed
On 14 Jan, 2020
Editor assigned
On 14 Jan, 2020
Submission checks complete
On 13 Jan, 2020
Editor invited
On 13 Jan, 2020
Version 1
Posted 07 Oct, 2019
No comments provided
Review #2 received
Received 08 Nov, 2019
Editorial decision: Major revision
On 08 Nov, 2019
Review #1 received
Received 02 Nov, 2019
Reviewer #2 agreed
On 22 Oct, 2019
Reviewer #1 agreed
On 17 Oct, 2019
Reviewers invited
Invitations sent on 14 Oct, 2019
Submission checks complete
On 30 Sep, 2019
Editor assigned
On 16 Sep, 2019
Editor invited
On 15 Sep, 2019
First submitted
On 12 Sep, 2019
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Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
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A new preprint design is coming!
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See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Kondwani Kawaza
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9432-4916
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
No community comments so far
Editorial decision: Accept
On 02 Mar, 2020
Editor assigned
On 28 Feb, 2020
Submission checks complete
On 27 Feb, 2020
Editor invited
On 27 Feb, 2020
No comments provided
Review #2 received
Received 30 Jan, 2020
Editorial decision: Minor revision
On 30 Jan, 2020
Reviewer #2 agreed
On 20 Jan, 2020
Review #1 received
Received 20 Jan, 2020
Reviewers invited
Invitations sent on 14 Jan, 2020
Reviewer #1 agreed
On 14 Jan, 2020
Editor assigned
On 14 Jan, 2020
Submission checks complete
On 13 Jan, 2020
Editor invited
On 13 Jan, 2020
Version 1
Posted 07 Oct, 2019
No comments provided
Review #2 received
Received 08 Nov, 2019
Editorial decision: Major revision
On 08 Nov, 2019
Review #1 received
Received 02 Nov, 2019
Reviewer #2 agreed
On 22 Oct, 2019
Reviewer #1 agreed
On 17 Oct, 2019
Reviewers invited
Invitations sent on 14 Oct, 2019
Submission checks complete
On 30 Sep, 2019
Editor assigned
On 16 Sep, 2019
Editor invited
On 15 Sep, 2019
First submitted
On 12 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district level facilities where most deliveries occur is warranted.
Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to comprehensively assess quality of care in addition to availability and quantity of supplies and resources. Because this study focused on neonatal care, the modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017.
Results: The continuum of labour, delivery and neonatal care were all assessed and areas that required improvements to meet standards of care were identified. Critical areas for improvements included the facilities for delivery, including operations and newborn care; for equipment and supplies; for neonatal case management, including sick newborns and routine monitoring and follow-up. Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed.
Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.
This is a list of supplementary files associated with this preprint. Click to download.
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