Resilience to maintain quality of care during birth in war torn Yemen: A
retrospective criterion-based audit from a congested frontline hospital
Abstract
OBJECTIVES: To audit quality of intrapartum care and birth outcomes
before and after a restriction in the number of women admitted in
childbirth. This restriction policy was implemented as number of births
vastly exceeded the pre-dimensioned capacity. DESIGN: A retrospective,
comparative criterion-based audit. SETTING: Taiz Houbane Maternal and
Child Health Hospital, Yemen. POPULATION: All women giving birth in a
high-volume month (August 2017; n=1034) and a low-volume month (November
2017; n=436). METHOD: Criterion-based audit of case files was conducted
for all caesarean sections (n=108 and n=82) and for 250 randomly
selected vaginal births in each month. Birth outcomes were assessed for
all women and newborns. MAIN OUTCOME MEASURES: Prevalence of sub-optimal
quality of intrapartum care and adverse birth outcomes (stillbirths,
intra-facility newborn deaths, and Apgar score <7). RESULTS:
Background characteristics of women were comparable between the months.
Rates of labour inductions and caesarean sections increased
significantly in the low-volume month (14% vs. 22% (relative risk (RR)
0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR
0.55, 95% CI 0.42-0.71), respectively). No other care or birth outcome
indicators were significantly different. Structural and human resources
remained constant throughout, despite differences in patient volume.
CONCLUSIONS: Assumptions regarding quality of care in periods of high
demand may be misguiding - resilience to maintain quality of care was
strong. We recommend health actors to closely monitor changes in quality
of care when implementing resource changes - to enable safe care at
birth for as many women as possible. FUNDING: Médecins Sans Frontières