Background: Maternity care is an important indicator of
national health systems, and the quality of maternity services is an essential
factor in reducing maternal and newborn morbidity and mortality, which remains
extremely high in Africa. Maternal and child mortality have their highest
incidence around delivery time. In Mozambique, the maternal mortality rate was
451.6 deaths per 100,000 live births (2017). The reasons for this are complex,
but one important factor in reducing this burden is to provide effective and
efficient care, to improve institutional deliveries. To reduce maternal and new-born mortality
rates in Nampula, researchers from Lúrio University and the University of
Saskatchewan, carried out an implementation research program, including different
interventions such as training activities for health professionals in maternal
and child health care, information campaigns through radio, theatre and
meetings, and transport for deliveries in maternity. A mid-project evaluation
was planned to assess the training’s impact on the quality of services at
Marrere Hospital Maternity.
Methods: Quantitative pre-post study, carrying out two
cross-sectional surveys about maternity service quality, one being conducted
after five health professionals’ training and the other after six more
training. The two surveys included samples of post-partum women in maternity,
calculated with a 10% margin error and 90% confidence interval for the first
survey, and with a 7% margin error and 95% confidence interval for the second.
The surveys were entered into REDCap and analysed to assess frequencies,
percentages, means, and standard deviations. This research was approved by the
Institutional Committees of Bioethics at Lúrio University and at the University
of Saskatchewan.
Results: 116 post-partum women were surveyed at the
maternity, assessing standards of patient-centred care during delivery labour.
Most areas showed no improvement. Some positive improvements were delivering
women were given the option to have a person of their choice accompany them
during labour (75%), notably a traditional birth attendant (34%), and they had
continuous support from a health professional (68%). But many shortcomings
persisted in areas of privacy (33%) and confidentiality (57%).
Discussion: Health professionals informed delivering women
that they had the option to have a person of their choice to accompany them
during labour, and this is a low-cost and effective intervention to improve the
quality of maternity care, in a context where Traditional Birth Attendants are
pregnant women’s trusted partners.
Most post-partum women in maternity were satisfied with the
service, perhaps due to their low education level leading to lower
expectations, since health professionals did not generally proceed according to
the rules of good care.
This finding might be related to the high turnover of mother
and child health professionals, by a mandated reduction of those professionals
with an overload of work to those remaining, associated with a hospital’s economic
resources reduction, in parallel with low salaries and missing payments for
extra-hours.
Conclusion: The quality of patient-centred care at Marrere
Hospital Maternity did not improve much with health professionals’ training.
Decreasing the large turnover rate of such staff, reviewing their learning
styles, and promoting continuous professional capacity building would be the
next steps to improve the quality of care. These policy developments could
significantly better mother and child health at Mozambican health centres and
hospitals.
Author (s) Details
Paulo Pires
Faculty of Health Sciences, Lúrio University, Bairro de Marrere, Rua Nr.
4250, Km 2.3, CP 364, Nampula, Mozambique.
Martins Abudo
Mupueleque
University Mussa Bin Bique, Nampula, Mozambique.
Jaibo Rassul Mucufo
Faculty of Health Sciences, Lúrio University, Nampula, Mozambique.
David Zakus
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Ronald SiemensFaculty
of Medicine, University of Saskatchewan, Saskatoon, Canada.
Celso Belo
Faculty of Health Sciences, Lúrio University, Nampula, Mozambique.
Please see the book here:- https://doi.org/10.9734/bpi/dhrni/v7/2172
