Progress Reports - Quality Assurance in Obstetrics

Abstract FIGO Quality Assurance in Obstetrics

Quality Assurance in Obstetrics: A Model to reduce maternal and fetal Mortality and Morbidity in 10 Hospitals in Kano and Kaduna State, Nigeria 

Hadiza Galadanci, Wolfgang Künzel, Dolapo Shittu, Manfred Gruhl, Robert Zinser

Achieving the MDGs 4 and 5 has continued to be a challenge in Nigeria, with maternal mortality ratio being one of the highest in the world.

Objective
The activities are aimed to establish an Institute of Quality Assurance in Obstetrics to improve the outcome of mothers and their children. 

Methods
The project commenced in January 2008 with 5 hospitals from Kano and 5 hospitals from Kaduna state of Nigeria, with analysing the structure of the hospitals, then raising the quality of obstetrical services to improve the quality of process and outcome. The hospitals participate in a continuous monthly data collection of maternal and child mortality and morbidity. In addition maternal death forms are filled for each maternal death to provide further insight into the maternal deaths. In a half yearly quality circles, staff from the participating hospitals discuss under supervision the “blinded” results of each hospital. 

Results
The structure of the hospitals exhibited deficits in many areas, such as equipment in the delivery rooms, operating theatres and staff. There were great variations in the maternal statistics across the 10 hospitals. The average MMR reduced from 1790/100,000 in the first half of 2008 to 1630/100,000 in the second half of 2008. The average FMR increased slightly from 849/1000 to 886/1000. There was an inversely proportional relationship between the total number of deliveries in a hospital and MMR. Also the FMR decreases with increase in deliveries. The average CS rate decreased from 7.18% to 6.12% respectively.

Conclusion
Quality assurance in obstetrics is a continuous process of analysing and discussing the MMR and FMR under guidance of an Institute of Quality Assurance. This might be a model to reduce the unacceptable high MMR and FMR. 

Keywords
Quality Assurance in Obstetrics, Maternal Morbidity, Maternal Mortality Ratio, Caesarean Section Rate, MDG, Nigeria, Fetal Mortality Rate

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