title: Development of an instrument to evaluate intrapartum care quality in Senegal: evaluation quality care.
abstract: OBJECTIVE
  To evaluate the reliability of direct observation for measuring intrapartum care and compare this method with clinical audits using objective criteria based on patients' medical charts.
  
  
  METHODS
  Cross-sectional study, data collected by two independent evaluators.
  
  
  METHODS
  Hospital in Dakar, Senegal.
  
  
  METHODS
  Thirty consecutive intrapartum care episodes provided by midwives and the corresponding medical charts. Outcome Measure The presence or absence of each of twelve criteria selected on the basis of national and international norms for monitoring of labour and delivery (six criteria) and the immediate postpartum period (six criteria).
  
  
  RESULTS
  For direct observation, the labour and delivery mean quality scores ranged from 5.34 to 5.77. In contrast, for the chart-based method, the scores ranged from 0.32 to 0.45. For postpartum care evaluated only with direct observation, the scores were also high (5.21-5.65). For direct observation, inter-evaluator agreement was high: kappa coefficients varied from 0.78 to 0.93 depending on the criterion (total score ICC = 0.74). For the chart-based method, inter-evaluator agreement was also high: 0.66 to 1 (total score ICC = 0.72). Comparison of the two methods showed strong differences by items and subscores.
  
  
  CONCLUSIONS
  Using direct observation, the quality of obstetric care was high for both the monitoring of labour and delivery and postpartum care. Both measurement instruments showed high reliability. The chart-based method underestimated the quality of care because of poor medical record documentation. Medical-record-based measurement may not be appropriate for the evaluation of the quality of obstetric care in Senegal and other low-income settings.
authors.affiliation: adamfaye94@gmail.com.
authors.forename: Adama
authors.initials: A
authors.lastname: Faye
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dumont
authors.forename: Papa
authors.initials: P
authors.lastname: Ndiaye
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000592:standards*; D005260:Female; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration* / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012675:Senegal
keywords: Senegal; obstetric care; quality; reliability