Trial reportTropical medicine & international health : TM & IH2019
Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster-randomised study in rural Tanzania.
Trial report in Tropical medicine & international health : TM & IH, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Effectiveness of Regionalization of Perinatal Care and Specific Facility-Based Interventions: A Systematic Review.Neonatology · 2025Pooled it
- How can human resources for health interventions contribute to sexual, reproductive, maternal, and newborn healthcare quality across the continuum in low- and lower-middle-income countries? A systematic review.Human resources for health · 2021Pooled it
- Improving health care facility birth rates in Rorya District, Tanzania: a multiple baseline trial.BMC pregnancy and childbirth · 2022Trial
- Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial.PLoS medicine · 2019Trial
- Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)-a stepped wedge cluster randomized controlled trial in public hospitals.Implementation science : IS · 2019Trial
- Maternal perceptions of medical service quality: evidence from a SERVQUAL-IPA model at a hospital in Beijing.BMC pregnancy and childbirth · 2025Article
- Improving complex health systems and lived environments for maternal and perinatal well-being in urban sub-Saharan Africa: the UrbanBirth Collective.Journal of global health · 2025Article
- Epidemiology, outcomes, and access to care for pediatric patients who underwent surgery in Northern Tanzania: A cross-sectional study.PLOS global public health · 2025Article
- The Meso-Level in Quality Improvement: Perspectives From a Maternal-Neonatal Health Partnership in South Africa.International journal of health policy and management · 2024Article
- Barriers and enablers to emergency obstetric and newborn care services use in Wolaita Zone, Southern Ethiopia: a qualitative case study.BMC public health · 2022Article
- Effect of healthcare quality initiative on maternal healthcare service utilization: a case study of the SPRING Ghana project.Journal of public health in Africa · 2022Article
- Associations between women's empowerment, care seeking, and quality of malaria care for children: A cross-sectional analysis of demographic and health surveys in 16 sub-Saharan African countries.Journal of global health · 2022Article
- The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study.BMC health services research · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesReduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub-optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth.
methodsIn this cluster-randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in-service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference-in-differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation.
resultsThe intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup.
conclusionsWe attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.
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