title: Criteria-based audit to improve women-friendly care in maternity units in Malawi.
abstract: OBJECTIVE
  To assess and improve women-friendly care in maternity units in Malawi.
  
  
  METHODS
  We interviewed 280 women about the care they received during childbirth at 29 different health centers. Results were compared with standards for women-friendly care, developed locally and based on evidence from World Health Organization manuals. The audit results were presented, and recommendations were made and implemented. A re-audit (involving 367 women) was conducted 3 months later.
  
  
  RESULTS
  Significant improvements were recorded on greeting clients (74.6 vs 87.7%; P < 0.001), respect for clients (91.1 vs 98.6%; P < 0.001), support by a companion during labor (58.9 vs 75.6%; P < 0.001), informing clients about different birthing positions (68.6 vs 79.3%; P = 0.002), allowing clients to adopt different birthing positions (67.9 vs 83.4%; P < 0.001), cleanliness of maternity wards (89.6 vs 97.0%; P < 0.001), speaking to clients using simple language (92.1 vs 98.6%; P < 0.001), ensuring privacy with curtains or screens (86.1 vs 92.1%; P < 0.012), and client willing to recommend the health facility to a friend (94.6 vs 98.6%; P = 0.004). However, there were no significant changes in the level of self-introduction by providers (62.5 vs 68.7%; P = 0.103) and provision of a clean bathroom and toilet (83.6 vs 80.4%; P = 0.282). Surprisingly, there was a significant deterioration in the use of linen to ensure privacy (86.4% vs 74.9%; P < 0.001). Overall, satisfaction of women increased by 9%.
  
  
  CONCLUSIONS
  The criteria-based audit was associated with an improvement in the quality of women-friendly care services in maternity units in Malawi.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, UK. kongnyuy@liverpool.ac.uk
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Kongnyuy
authors.forename: Grace
authors.initials: G
authors.lastname: Mlava
authors.forename: Nynke
authors.initials: N
authors.lastname: van den Broek
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D054869:Clinical Audit; D005260:Female; D006268:Health Facilities / Q000592:standards; D006801:Humans; D008295:Malawi; D009774:Obstetrics / Q000379:methods / Q000592:standards; D017060:Patient Satisfaction; D011247:Pregnancy; D011787:Quality of Health Care