Academic journal article Iranian Journal of Public Health

Are Women of East Kazakhstan Satisfied with the Quality of Maternity Care? Implementing the WHO Tool to Assess the Quality of Hospital Services

Academic journal article Iranian Journal of Public Health

Are Women of East Kazakhstan Satisfied with the Quality of Maternity Care? Implementing the WHO Tool to Assess the Quality of Hospital Services

Article excerpt


Over the last decades the world has witnessed how the character and the priority status of maternal and child health have changed. Previously, mothers and children were considered target audience for object-oriented programs, while now they demand quality medical and social aid in their status of rights-holders, guaranteed by the state. Thus, quality care should be a key component for development and implementation of all programs and strategies targeting women and children, particularly in the field of perinatal care (1).

In order to promote maternal and child health in Kazakhstan, in 2002 WHO started implementing effective perinatal technologies within the framework of Safe Motherhood initiative (2). Quality of care assessments were continuously performed in a number of tertiary level obstetrical hospitals in Kazakhstan within a period of about three years (Nov 2009 and Apr 2011). Still, these assessments only covered South Kazakhstan, which is predominantly agricultural and is characterized by more traditional way of life. Although not more than 10 mothers were interviewed in each facility, these assessments helped to identify the problematic areas in management of normal labor, postpartum hemorrhage, and in basic care for newborns, including thermal regulation (3).

Inadequate prenatal care is associated with adverse pregnancy outcomes (4). The systematic review evaluating evidence for the determinants of prenatal healthcare utilization demonstrated the lack of studies to ensure adequate prenatal care for pregnant women at risk (5).

To enable assessment of health care performance, the WHO Regional Office for Europe developed the "Quality of hospital Care for mothers and newborns babies (QoMNC), WHO assessment tool" (from here Tool) in order to provide support for systematic evaluation of quality of care in a number of European countries, including Commonwealth of Independent States. In addition, this Tool was designed to reveal topics that require prompt consideration and priority actions for quality improvement. The Tool was designed in 2009, and in 2014, it was revised and amended to include major changes, based on the latest WHO recommendations and other international standards (6). In this study, we used the first edition of the Tool as we finished the data collection in Nov 2013.

This study was conducted to evaluate the satisfaction of mothers with the quality of hospital services in East Kazakhstan is relevant for an international audience working in maternity care and childbirth because it reveals how programs and instruments designed and tailored for global use could be effectively implemented at the local level.

Materials and Methods

The study was conducted in East-Kazakhstan region with a population of 1,393,619 people (7). Data on regional population were obtained from web sites of the Agency of the Republic of Kazakhstan on Statistics (8) and the Department of Statistics of East Kazakhstan region (7). Semey is a city located in the Northeast of Kazakhstan; it is one of the largest industrial cities in the country and is internationally known for being a centre of Soviet nuclear weapons testing. Kalbatau is a big village in northeastern Kazakhstan and Zyryanovsk is a small town in eastern Kazakhstan, located almost at the border with Russian Federation.

Obstetrical services included in this study are presented by five maternity facilities of East-Kazakhstan region: two urban maternity hospitals and Perinatal Centre (the tertiary referral maternity hospital with Neonatal Intensive Care Unit) located in Semey City and two maternity facilities of rural hospitals located in Kalbatau and Zyryanovsk. The requirement for this selection was the inclusion of two city-level maternity hospitals, two rural maternity facilities and one referral/teaching maternity hospital.

The quality of hospital care for mothers and newborn babies was evaluated with the help of the Assessment tool, designed by the Institute of Child Health, Trieste, Italy in collaboration with the WHO Regional Office for Europe. …

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