title: Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement.
abstract: OBJECTIVE
  To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies.
  
  
  METHODS
  In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into "bundles" based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009.
  
  
  RESULTS
  During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (P<0.05) and from 14.8% to 1.9% (P<0.001), respectively. Stillbirths were reduced by 36% (P<0.05). Overall, the maternal mortality ratio decreased from 496 per 100000 live births in 2007 to 328 per 100,000 in 2009.
  
  
  CONCLUSIONS
  Maternal and newborn mortality were reduced in a low-resource setting when appropriate models for continuous quality improvement were developed and employed.
authors: Ridge Regional Hospital, Ghana Health Service, Accra, Ghana.
authors: Emmanuel
authors: E
authors: Srofenyoh
authors: Thomas
authors: T
authors: Ivester
authors: Cyril
authors: C
authors: Engmann
authors: Adeyemi
authors: A
authors: Olufolabi
authors: Laurel
authors: L
authors: Bookman
authors: Medge
authors: M
authors: Owen
mesh_terms: D005260:Female; D005869:Ghana; D006761:Hospitals; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality* / Q000517:prevention & control; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D008507:Medically Underserved Area; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality* / Q000517:prevention & control; D058996:Quality Improvement; D012040:Regional Health Planning