Dataset for the article: Standards-based audit to improve quality of maternal and newborn care – a stepped-wedge cluster randomised trial in Malawi

White, Sarah ORCID: https://orcid.org/0000-0001-5535-8075, Mgawadere, Florence ORCID: https://orcid.org/0000-0003-3341-9118, Gopalakrishnan, Somla ORCID: https://orcid.org/0000-0002-7833-5367 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2023) Dataset for the article: Standards-based audit to improve quality of maternal and newborn care – a stepped-wedge cluster randomised trial in Malawi. [Data Collection]

Summary

Background
Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve compliance with standards of care developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care in a low resource setting.

Methods
A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps (months) was conducted in 44 healthcare facilities in Malawi. A total of 25 standards were developed. Each facility had two consecutive audit cycle periods in each of which one (health centres) or two standards (hospitals) were audited in each period. Each audit cycle consisted of five steps: (i) agree the standard to be audited, (ii) measure compliance with standard, (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance. For steps ii) and v), compliance with a standard was to be assessed for 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards.

Results
Standards-based audit was an effective method to improve the quality of care. The crude overall compliance rate rose from 45% in the control phase (pre-action in audit cycle) to 63% in the intervention phase (post-action). There was a statistically significant improvement in compliance for standards audited: the adjusted (for standard, facility type, month, and healthcare facility by month clustering) OR (95% CI) was 2.80 (1.65,4.76). The most frequently taken actions to improve compliance with standards included: i) providing support to improve staff performance to better carry out clinical duties and improve general conduct through re-orientation and staff meetings as well as improved supervision, and, ii) ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostics, partograph).

https://doi.org/10.1371/journal.pone.0310896