Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study

English version

Autoři: Victoria B. Chou ^aff001; Neff Walker ^aff001; Mufaro Kanyangarara ^aff001
Působiště autorů: Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America ^aff001
Vyšlo v časopise: Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study. PLoS Med 16(12): e32767. doi:10.1371/journal.pmed.1002990
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002990

Souhrn

Background

In low-resource settings where disease burdens remain high and many health facilities lack essentials such as drugs or commodities, functional equipment, and trained personnel, poor quality of care often results and the impact can be profound. In this paper, we systematically quantify the potential gain of addressing quality of care globally using country-level data about antenatal, childbirth, and postnatal care interventions.

Methods and findings

In this study, we created deterministic models to project health outcomes if quality of care was addressed in a representative sample of 81 low- and middle-income countries (LMICs). First, available data from health facility surveys (e.g., Service Provision Assessment [SPA] and Service Availability and Readiness Assessment [SARA]) conducted 2007–2016 were linked to household surveys (e.g., Demographic and Health Surveys [DHS] and Multiple Indicator Cluster Surveys [MICS]) to estimate baseline coverage for a core subset of 19 maternal and newborn health interventions. Next, models were constructed with the Lives Saved Tool (LiST) using country-specific baseline levels in countries with a linked dataset (n = 17) and sample medians applied as a proxy in countries without linked data. Lastly, these 2016 starting baseline levels were raised to reach targets in 2020 as endline based upon country-specific utilization (e.g., proportion of women who attended 4+ antenatal visits, percentage of births delivered in a health facility) from the latest DHS or MICS population-based reports. Our findings indicate that if high-quality health systems could effectively deliver this subset of evidence-based interventions to mothers and their newborns who are already seeking care, there would be an estimated 28% decrease in maternal deaths, 28% decrease in neonatal deaths, and 22% fewer stillbirths compared to a scenario without any change or improvement in quality of care. Totals of 86,000 (range, 77,800–92,400) maternal and 0.67 million (range, 0.59 million–0.75 million) neonatal lives could be saved, and 0.52 million (range, 0.48 million–0.55 million) stillbirths could be prevented across the 81 countries in the calendar year 2020 when adequate quality care is provided at current levels of utilization. Limitations include the paucity of data to individually assess quality of care for each intervention in all LMICs and the necessary assumption that quality of care being provided among the subset of countries with linked datasets is comparable or representative of LMICs overall.

Conclusions

Our findings suggest that efforts to close the quality gap would still produce substantial benefits at current levels of access or utilization. With estimated mortality rate declines of 21%–32% on average, gains from this first step would be significant if quality was improved for selected antenatal, intrapartum, and postnatal interventions to benefit pregnant women and newborns seeking care. Interventions provided at or around the time of childbirth are most critical and accounted for 64% of the impact overall estimated in this quality improvement analysis.

Klíčová slova:

Antenatal care – Death rates – Global health – Labor and delivery – Neonatal care – Neonates – Quality of care – Stillbirths

Zdroje

1. World Health Organization. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva; 2007.

2. Victora CG, Requejo JH, Barros AJ, Berman P, Bhutta Z, Boerma T, et al. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. Lancet. 2016;387(10032):2049–59. doi: 10.1016/S0140-6736(15)00519-X 26477328

3. Countdown to 2030 Collaboration. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet. 2018;391(10129):1538–48. doi: 10.1016/S0140-6736(18)30104-1 29395268

4. Montagu D, Sudhinaraset M, Diamond-Smith N, Campbell O, Gabrysch S, Freedman L, et al. Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia. Health Policy Plan. 2017;32(8):1146–52. doi: 10.1093/heapol/czx060 28541422

5. Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comande D, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016;388(10056):2176–92. doi: 10.1016/S0140-6736(16)31472-6 27642019

6. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347–70. doi: 10.1016/S0140-6736(14)60792-3 24853604

7. de Bernis L, Kinney MV, Stones W, Ten Hoope-Bender P, Vivio D, Leisher SH, et al. Stillbirths: ending preventable deaths by 2030. Lancet. 2016;387(10019):703–16. doi: 10.1016/S0140-6736(15)00954-X 26794079

8. Leslie HH, Hirschhorn LR, Marchant T, Doubova SV, Gureje O, Kruk ME. Health systems thinking: A new generation of research to improve healthcare quality. PLoS Med. 2018;15(10):e1002682. doi: 10.1371/journal.pmed.1002682 30376581

9. Kruk ME, Pate M, Mullan Z. Introducing The Lancet Global Health Commission on High-Quality Health Systems in the SDG Era. Lancet Glob Health. 2017;5(5):e480–e1. doi: 10.1016/S2214-109X(17)30101-8 28302563

10. Allen E, Schellenberg J, Berhanu D, Cousens S, Marchant T. Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia. PLoS ONE. 2018;13(8):e0199937. doi: 10.1371/journal.pone.0199937 30071026

11. Gage AD, Kruk ME, Girma T, Lemango ET. The know-do gap in sick child care in Ethiopia. PLoS ONE. 2018;13(12):e0208898. doi: 10.1371/journal.pone.0208898 30540855

12. Tuncalp O, Were WM, MacLennan C, Oladapo OT, Gulmezoglu AM, Bahl R, et al. Quality of care for pregnant women and newborns-the WHO vision. BJOG. 2015;122(8):1045–9. doi: 10.1111/1471-0528.13451 25929823

13. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743–8. doi: 10.1001/jama.260.12.1743 3045356

14. Akachi Y, Kruk ME. Quality of care: measuring a neglected driver of improved health. Bull World Health Organ. 2017;95(6):465–72. doi: 10.2471/BLT.16.180190 28603313

15. Bryce J, Arnold F, Blanc A, Hancioglu A, Newby H, Requejo J, et al. Measuring coverage in MNCH: new findings, new strategies, and recommendations for action. PLoS Med. 2013;10(5):e1001423. doi: 10.1371/journal.pmed.1001423 23667340

16. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet. 2003;362(9377):65–71. doi: 10.1016/S0140-6736(03)13811-1 12853204

17. Walker N, Tam Y, Friberg IK. Overview of the Lives Saved Tool (LiST). BMC Public Health. 2013;13 Suppl 3:S1.

18. Ng M, Fullman N, Dieleman JL, Flaxman AD, Murray CJ, Lim SS. Effective coverage: a metric for monitoring Universal Health Coverage. PLoS Med. 2014;11(9):e1001730. doi: 10.1371/journal.pmed.1001730 25243780

19. Boschi-Pinto C, Young M, Black RE. The Child Health Epidemiology Reference Group reviews of the effectiveness of interventions to reduce maternal, neonatal and child mortality. Int J Epidemiol. 2010;39 Suppl 1:i3–6.

20. You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275–86. doi: 10.1016/S0140-6736(15)00120-8 26361942

21. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4(2):e98–e108. doi: 10.1016/S2214-109X(15)00275-2 26795602

22. Kanyangarara M, Chou VB. Linking household surveys and health facility assessments to estimate intervention coverage for the Lives Saved Tool (LiST). BMC Public Health. 2017;17(Suppl 4):780. doi: 10.1186/s12889-017-4743-4 29143639

23. Kanyangarara M, Chou VB, Creanga AA, Walker N. Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries. J Glob Health. 2018;8(1):010603. doi: 10.7189/jogh.08.010603 29862026

24. Burden C, Bradley S, Storey C, Ellis A, Heazell AE, Downe S, et al. From grief, guilt pain and stigma to hope and pride—a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy Childbirth. 2016;16:9. doi: 10.1186/s12884-016-0800-8 26785915

25. Moucheraud C, Worku A, Molla M, Finlay JE, Leaning J, Yamin A. Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987–2011). Reprod Health. 2015;12 Suppl 1:S4.

26. Molla M, Mitiku I, Worku A, Yamin A. Impacts of maternal mortality on living children and families: A qualitative study from Butajira, Ethiopia. Reprod Health. 2015;12 Suppl 1:S6.

27. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e252. doi: 10.1016/S2214-109X(18)30386-3 30196093

28. Vogel JP, Oladapo OT, Pileggi-Castro C, Adejuyigbe EA, Althabe F, Ariff S, et al. Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials. BMJ Glob Health. 2017;2(3):e000398. doi: 10.1136/bmjgh-2017-000398 29082019

29. Hancioglu A, Arnold F. Measuring coverage in MNCH: tracking progress in health for women and children using DHS and MICS household surveys. PLoS Med. 2013;10(5):e1001391. doi: 10.1371/journal.pmed.1001391 23667333

30. Persson LA. Bridging the quality chasm in maternal, newborn, and child healthcare in low- and middle-income countries. PLoS Med. 2017;14(12):e1002465. doi: 10.1371/journal.pmed.1002465 29232389

31. Kruk ME, Gage AD, Joseph NT, Danaei G, Garcia-Saiso S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet. 2018;392(10160):2203–12. doi: 10.1016/S0140-6736(18)31668-4 30195398

32. Saad-Haddad G, DeJong J, Terreri N, Restrepo-Mendez MC, Perin J, Vaz L, et al. Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries. J Glob Health. 2016;6(1):010404. doi: 10.7189/jogh.06.010404 27231540

33. Bhattacharya AA, Umar N, Audu A, Felix H, Allen E, Schellenberg JRM, et al. Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria. PLoS ONE. 2019;14(1):e0211265. doi: 10.1371/journal.pone.0211265 30682130