(919) Exploring obstetric staffing and association with quality of care at tertiary care facilities in Uganda

Methods: We reviewed a random sample of births at six tertiary-level facilities in Uganda in July 2021. We determined the proportion of births meeting three quality metrics defined by WHO Standards for Improving Quality of Maternal and Newborn Care in Health Facilities (Table 1), and the daily median provider-to-births ratio (daily number of provider-type divided by daily births). We compared the proportion of births achieving the quality metrics across facilities using a chi-squared test and assessed the association between quality metrics and provider ratios using logistic regression, accounting for clustering by facility.

Results:

We sampled 819 births. For all three metrics (Table 1) there was significant variation in the proportion of births meeting quality metrics. Overall, 20% had vital signs assessed (range: 0-81%, p< 0.01), 60% were monitored by partograph (range: 28-98%, p< 0.01) and 68% received oxytocin after birth (range: 0.9-100%, p< 0.01). Median provider ratios varied significantly, with the widest variation seen in midwife ratios (range 0.6-5.8/birth, p< 0.01).  Higher midwife-to-birth ratio was associated with vital sign assessment and partograph use (p < 0.01), and increased obstetrician ratios was associated with less oxytocin administered (p < 0.01).

Conclusion:

We found improved rates of adherence to two WHO quality metrics with a higher midwife-to-birth ratio. Future research is needed to understand other drivers of quality care provision and to determine best practices at facilities achieving high standards of care.