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Background: Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care. This study evaluates the effect of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by "clinical bundle" adherence over-time.Methods: The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three "clinical bundles" were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births. A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime. Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.Findings: Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four MNH collaborative. In Tankua Abergele collaborative (Tigray Region), the overall mean adherence to "On Admission" bundle was 86% with β = 1.39 (95% CI; 0.47-2.32; P <  0.005) on average monthly. Similarly, the overall mean adherence to the "Before Pushing" bundle in Dugna Fango collaborative; Southern Nations, Nationalities and People's (SNNP) region was 80% with β = 2.3 (95% CI; 0.89-3.74; P <  0.005) on average monthly.Conclusion: Using WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes. [ABSTRACT FROM AUTHOR]

Background: Quality improvement (QI) methods are effective in improving healthcare delivery using sustainable, collaborative, and cost-effective approaches. Systems-integrated interventions offer promise in terms of producing sustainable impacts on service quality and coverage, but can also improve important data quality and information systems at scale.Methods: This study assesses the preliminary impacts of a first phase, quasi-experimental, QI health systems intervention on maternal and neonatal health outcomes in four pilot districts in Ethiopia. The intervention identified, trained, and coached QI teams to develop and test change ideas to improve service delivery. We use an interrupted time-series approach to evaluate intervention effects over 32-months. Facility-level outcome indicators included: proportion of mothers receiving four antenatal care visits, skilled delivery, syphilis testing, early postnatal care, proportion of low birth weight infants, and measures of quality delivery of childbirth services.Results: Following the QI health systems intervention, we found a significant increase in the rate of syphilis testing (ß = 2.41, 95% CI = 0.09,4.73). There were also large positive impacts on health worker adherence to safe child birth practices just after birth (ß = 8.22, 95% CI = 5.15, 11.29). However, there were limited detectable impacts on other facility-usage indicators. Findings indicate early promise of systems-integrated QI on the delivery of maternal health services, and increased some service coverage.Conclusions: This study preliminarily demonstrates the feasibility of complex, low-cost, health-worker driven improvement interventions that can be adapted in similar settings around the world, though extended follow up time may be required to detect impacts on service coverage. Policy makers and health system workers should carefully consider what these findings mean for scaling QI approaches in Ethiopia and other similar settings. [ABSTRACT FROM AUTHOR]

Background: Antenatal care is the care provides for a pregnant mother to improve the health of the mother and her baby. But in the World including Ethiopia still, mothers do not receive the required number of antenatal care visits. Therefore, the main aim of this study was to identify determinants of Antenatal care visit dropout in Bahir Dar Zuria Woreda North West Ethiopia.Methods: The study was community-based unmatched case-control study that employed both quantitative and qualitative data. For the quantitative part, 134 cases and 266 controls (total 400) women who gave births in the last six months prior to the study in Bahir Dar Zuria Woreda were enrolled. Data were collected through face to face interviews from March 1 to 30, 2018 using a structured questionnaire. Bivariate and multivariate analysis was used. 95% confidence interval and P-value was used to measure the level of significance. For the qualitative part, six FGDs were conducted and open code software was used for the analysis of the data. The finding was narrated by triangulating with the quantitative findings.Result: Being far distance (AOR 7.26; 95% CI 4.23, 23.01), not having a companion (AOR 3.49; 95% CI; 2.39, 8.44), lack of knowledge (AOR 2.57; 95% CI; 1.25, 5.28), poor wealth index (AOR; 3.36, 95% CI 1.71, 6.62) and not developing a danger sign (AOR 2.18; 95% CI 2.28, 7.64) were predictors of ANC dropout. In addition to this, in the qualitative finding, the socio-culture of the community, attitudes, experience, and perception of the existing services and service provisions were also determinants of ANC drop out.Conclusion: Socio-cultural, economic, accessibility, and individual factors were determinants of ANC visit drop out. In addition, the behavior of the professional, the mother understands of the existing services, and their perception about ANC influenced ANC dropout. [ABSTRACT FROM AUTHOR]