title: Training and nutritional components of PMTCT programmes associated with improved intrapartum quality of care in Mali and Senegal.
abstract: OBJECTIVE
  Scale-up of prevention of mother-to-child transmission (PMTCT) of HIV programmes in sub-Saharan Africa has stimulated interest to assess whether these programmes can indirectly affect other health priorities. This study assesses whether PMTCT programmes, or components of these programmes, are associated with better obstetrical quality of care and how PMTCT may reinforce existing maternal health programmes.
  
  
  METHODS
  Cross-sectional analysis of data from a cluster-randomized trial called QUARITE.
  
  
  METHODS
  Mali and Senegal, West Africa.
  
  
  METHODS
  Thirty-one referral hospitals and 612 obstetrical patients.
  
  
  METHODS
  The exposure of interest was PMTCT measured with a scale containing 10 components describing different prongs of a hospital PMTCT programme. Other variables of interest included: presence of a quality of care improvement programme, hospital resources and patient demographic characteristics.
  
  
  METHODS
  Obstetrical quality of care measured through a validated chart abstraction tool.
  
  
  RESULTS
  Of 45 points, the mean hospital PMTCT score was 26.1 (SD: 6.7). Total PMTCT score was not significantly associated with quality of care, but programme component scores were. After adjustment for known predictors of quality of care, staff training in PMTCT (P = 0.03) and complementary nutritional services (P = 0.03) were significantly associated with better quality obstetrical care. A point increase in scores for either of these components was associated with 40% greater odds of good obstetrical care.
  
  
  CONCLUSIONS
  PMTCT training and nutritional components are significantly associated with better quality intrapartum care. Health professionals' training in maternal healthcare and PMTCT could be combined to improve the quality of obstetric care in the region.
authors.affiliation: Axe Santé publique et pratiques optimales en santé, Centre de recherche du CHUQ, 2875, boulevard Laurier, Édifice Delta II, Bureau 600, 6e étage, Québec (Québec), Canada G1V 2M2. catherine-mclean.pirkle.1@ulaval.ca.
authors.forename: Catherine McLean
authors.initials: CM
authors.lastname: Pirkle
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dumont
authors.forename: Mamadou
authors.initials: M
authors.lastname: Traoré
authors.forename: Maria-Victoria
authors.initials: MV
authors.lastname: Zunzunegui
mesh_terms: D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000635:transmission; D006292:Health Priorities; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008302:Mali; D008427:Maternal Health Services / Q000458:organization & administration* / Q000592:standards; D009751:Nutritional Requirements; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012675:Senegal
keywords: PMTCT; West Africa; health systems; maternal health; obstetrics; quality of care