Maternal and Child Health Clinical Trial
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
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.
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.
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