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Resilience to maintain quality of care during birth in war torn Yemen: A retrospective criterion-based audit from a congested frontline hospital
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  • Josephine Obel,
  • Antonio Martin,
  • Abdul Mullahzada,
  • Ronald Kremer,
  • Nanna Maaloe
Josephine Obel
Hvidovre Hospital

Corresponding Author:[email protected]

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Antonio Martin
Medecins Sans Frontieres
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Abdul Mullahzada
Médecins Sans Frontières
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Ronald Kremer
Medecins Sans Frontieres Operational Centre Amsterdam
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Nanna Maaloe
University of Copenhagen Faculty of Health and Medical Sciences
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OBJECTIVES: To audit quality of intrapartum care and birth outcomes before and after a restriction in the number of women admitted in childbirth. This restriction policy was implemented as number of births vastly exceeded the pre-dimensioned capacity. DESIGN: A retrospective, comparative criterion-based audit. SETTING: Taiz Houbane Maternal and Child Health Hospital, Yemen. POPULATION: All women giving birth in a high-volume month (August 2017; n=1034) and a low-volume month (November 2017; n=436). METHOD: Criterion-based audit of case files was conducted for all caesarean sections (n=108 and n=82) and for 250 randomly selected vaginal births in each month. Birth outcomes were assessed for all women and newborns. MAIN OUTCOME MEASURES: Prevalence of sub-optimal quality of intrapartum care and adverse birth outcomes (stillbirths, intra-facility newborn deaths, and Apgar score <7). RESULTS: Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71), respectively). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. CONCLUSIONS: Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes - to enable safe care at birth for as many women as possible. FUNDING: Médecins Sans Frontières