Research Article: Use of a digital job-aid in improving antenatal clinical protocols and quality of care in rural primary-level health facilities in Burkina Faso: a quasi-experimental evaluation
Abstract:
Objective We assessed the impact of a digital clinical decision support (CDS) tool in improving health providers adherence to recommended antenatal protocols and service quality in rural primary-level health facilities in Burkina Faso. Design A quasi-experimental evaluation based on a cross-sectional post-intervention assessment comparing the intervention district to a comparison group. Setting and participants The study included 331 direct observations and exit interviews of pregnant women seeking antenatal care (ANC) across 48 rural primary-level health facilities in Burkina Faso in 2021. Intervention Digital CDS tool to improve health providers adherence to recommended antenatal protocols. Outcome measures We analysed the quality of care on both the supply and demand sides. Quality-of-care service scores were based on actual care provided and expected care according to standards. Pregnant women’s knowledge of counselling and satisfaction score after receiving care were also calculated. Other outcomes included time of clinical encounter. Results The overall quality of health service provision was comparable across intervention and comparison health facilities (52% vs 51%) despite there being a significantly higher proportion of lower skilled providers in the intervention arm (42.5% vs 17.8%). On average, ANC visits were longer in the intervention area (median 24?min, IQR 18) versus comparison area (median 12?min, IQR: 8). The intervention arm had a significantly higher score difference in women’s knowledge of received counselling (16.4 points, 95%?CI 10.37 to 22.49), and women’s satisfaction (16.18 points, 95% CI: 9.95 to 22.40). Conclusion Digital CDS tools provide a valuable opportunity to achieve substantial improvements of the quality of ANC and broadly maternal and newborn health in settings with high burden mortality and less trained health cadres when adequately implemented.
Introduction:
Burkina Faso has among the highest levels of maternal mortality rate in sub-Saharan Africa, estimated at 320 deaths per 100?000 live births. 1 The high burden of maternal deaths is in part attributable to the low coverage of critical antenatal care (ANC), intrapartum and postnatal services and poor quality of health services across the continuum of maternal care. 2 A study across the continuum of maternal care suggests that 71% of neonatal deaths, 33% of stillbirths and 54% of maternal deaths could be averted per…
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