Who we are:

In 2016, the World Health Organization (WHO) launched the Quality, Equity and Dignity (“QED”) project in nine countries, including Nigeria, with the aim of halving hospital-based maternal and new born deaths in five years. Among the quality of care (QoC) standards expected during childbirth to achieve QED objective, is that every mother and new-born have a complete, accurate, and standardized medical record during labour, childbirth and the early postnatal period. Health facilities in the nine ‘first wave’ countries are expected to have a mechanism for routine maternal and perinatal health (MPH) data collection, analysis and feedback to monitor and improve clinical performance. Among the QED project countries, Nigeria has been chosen to kick-start the establishment of electronic MPH databases, in a network of referral-level hospitals.

The Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) is a network of 54 Public and Private Hospitals across Nigeria. Each Hospital has Two Doctors (An Obstetrician and a Paediatrician), and Two Medical record officers.

This project will make use of a customised open-source electronic data management platform – District Health Information System 2 (DHIS2), for data collection, validation, analysis, and presentation at individual and aggregated levels. The DHIS2 is an open-source software used in more than 60 countries for reporting, analysing and disseminating data from health programs. Specifically, the maternal and perinatal health database for QED (MPD-4-QED) has been customized to be relevant to the Nigerian context, following due consultation with key stakeholders in maternal and perinatal care in the country.

 

General objective

To establish a harmonized electronic database system, based on routinely collected data during labour, childbirth, and early postnatal period, in a nationwide network of 60 public and private referral-level health facilities as a platform for improving quality of maternal and perinatal care in Nigeria.

Specific objectives

  1. To harmonize the system of collecting routine maternal and perinatal data during labour, childbirth and early postnatal period in public and private referral-level hospitals in Nigeria.
  2. To create an electronic platform that will enable routine healthcare data analysis, maternal and perinatal death audit, and facilitate reporting and feedback at local, state, regional and national levels for improvement in clinical care performance.
  3. To develop a platform for implementing Maternal and Perinatal Death Surveillance and Response (MPDSR) in Nigeria.

 

Target population

All women admitted in labour and who delivered in the participating hospitals and their newborn babies, all women admitted within 7 days of termination of pregnancy irrespective of the gestational age, and all babies admitted to the neonatal unit within 7 days of life regardless of where the delivery took place will be included in the database. Women are qualified for inclusion regardless of where they received antenatal care (ANC).

 

Study Procedure

At each facility, MROs working in the obstetrics and gynecological department, trained to proficiency in electronic health data capture will be the data collectors. Through daily visits to the obstetric and gynecological ward, birthing/delivery room, operating theatres, neonatal ward and intensive care units, the data collector will conduct surveillance of medical records and complete a tablet-enabled electronic data captured form for all eligible women. The form will be completed immediately after the discharge (or death) of the woman and/or baby. The collected data will cover the period that the woman and baby were on hospital admission.

The MROs will extract data on the care provided by midwives and doctors to the woman and her child, and their clinical care outcomes. The data will be extracted directly from the medical case records (medical folders) of the mother and baby. Data extraction will be restricted to what is available in the medical records and no information will be obtained directly from the woman or the hospital staff that cared for her. The woman or medical staff will not be interviewed. There will be no postnatal follow up.

In the event of death of a woman and/or the baby, information will be extracted from the medical records to enable identification of the clinical condition that was primarily responsible for the death, as well as the contributory factors surrounding the death. This information will be obtained from the audit that will be conducted by the hospital maternal and perinatal death audit teams. The hospital coordinator (an obstetrician and gynecologist) will be responsible for completing the segment of the form relating to maternal and stillbirth death audits, while the Assistant hospital coordinator (Paediatrician) will be responsible for perinatal death audits.

At each participating hospital, the hospital coordinator will oversee the data capture processes, where applicable train newly recruited MROs, validate the correctness of data captured into the tablet device, and ensure they are electronically transferred to the central server. The regional coordinator will coordinate participating hospitals in their respective geopolitical zone, conduct periodic facility audit and quality assurance check, and report to the national central coordinating team. The national coordinating team will manage all data and analyze aggregated data for facilities, regions and the country on quarterly basis as per QED indicators. However, each participating hospital will also have real-time access to their own electronic database through a designated code, for local audit, planning, care quality control, training and research.