Browsing by Author "Nsangamay, Tshimanga"

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    How to improve the quality of care for woman with postpartum haemorrhage at Onandjokwe Hospital, Namibia
    (Stellenbosch : Stellenbosch University, 2018-03) Nsangamay, Tshimanga; Mash, Robert; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Background: Although no studies on the quality of emergency obstetric care including care for postpartum haemorrhage have been published from Namibia, the condition is a major cause of maternal morbidity and mortality and the huge burden of pregnancy related death is disproportionately shared by low and middle income countries in Africa and Asia. Aim: The aim of this project was to assess and improve the quality of care for women with postpartum haemorrhage Setting: Onandjokwe Hospital (maternity ward), Namibia Methods: Quality improvement cycle Results: One hundred and fifty two files were audited (eighty two in the baseline audit and seventy in the re-audit). In the baseline audit twelve out of nineteen structural target standards were achieved and none of the process target standard were met. During the re-audit ten months later, statistically-significant improvement in performance(p < 0.05) was observed, all structural target standard were achieved, six out of nine process target standard and two out three outcome target standard were met. Conclusion: The quality of care for postpartum haemorrhage was substandard in our healthcare setting. Interventions were setup and implemented to improve the quality of care for postpartum haemorrhage. These interventions induced a significant improvement in structural and process criteria and a significant improvement was also seen in 91.4 % of women treated and stabilised from postpartum haemorrhage complications within six hours after being diagnosed during re-audit.
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    How to improve the quality of care for women with postpartum haemorrhage at Onandjokwe Hospital, Namibia : quality improvement study
    (BMC (part of Springer Nature), 2019-12-11) Nsangamay, Tshimanga; Mash, Bob
    Background: Postpartum haemorrhage (PPH) is the leading direct cause of maternal morbidity and mortality worldwide. The sustainable development goals aim to reduce the maternal mortality ratio to 70 per 100,000 live births. In Namibia, the ratio was reported as 265 per 100,000 live births in 2015 and yet little is published on emergency obstetric care. The majority of deliveries in Namibia are facility-based. The aim of this study was to assess and improve the quality of care for women with PPH at Onandjokwe Hospital, Namibia. Methods: A criterion-based audit cycle in all 82 women with PPH from 2015 using target standards for structure, process and outcomes of care. The audit team then planned and implemented interventions to improve the quality of care over a 10-month period. The audit team repeated the audit on all 70 women with PPH from the same 10- month period. The researchers compared audit results in terms of the number of target standards achieved and any significant change in the proportion of patients’ care meeting the predetermined criteria. Results: In the baseline audit 12/19 structural, 0/9 process and 0/3 outcome target standards were achieved. On follow up 19/19 structural, 6/9 process and 2/3 outcome target standards were met. There was one maternal death in the baseline group and none in the follow up group. Overall 6/9 process and 2/3 outcome criteria significantly improved (p < 0.05) from baseline to follow up. Key interventions included training of nursing and medical staff in obstetric emergencies, ensuring that guidelines and standard operating protocols were easily available, reorganising care to ensure adequate monitoring of women postpartum and ensuring that essential equipment was available and functioning. Conclusion: The study demonstrates that the quality of care for emergency obstetrics can be improved by audit cycles that focus on the structure and process of care. Other hospitals in Namibia and the region could adopt the process of continuous quality improvement and similar strategies