Improving Access to And Quality of Essential Obstetric and Newborn Care in Cotopaxi, Ecuador: A Controlled, Prospective Evaluation

Session: Access to Maternal Newborn Care: Improving Quality, Improving Outcomes

Presenter: Jorge Hermida, University Research Co., LLC
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Background: Despite temporal improvements in health care utilization, significant disadvantages persist among the rural, less educated and indigenous population in Ecuador. The Essential Obstetric and Neonatal Care (EONC) project created a multi-faceted provincial-level network of public and non-governmental health services, including community agents to improve access to, women’s and providers’ knowledge and practices, quality and coordination of EONC.

Methods: The 21 poorest, most indigenous parishes in Cotopaxi were targeted from May 2010-July 2013. Baseline and endline multi-stage household surveys in these (intervention) and neighboring comparison areas assessed the interventions’ effects on access to and use of care, women’s knowledge and practices, and quality of care. Intervention group traditional birth attendants’ (TBA) knowledge and skills were assessed by observation of simulation and facility EONC quality was assessed by quality improvement chart audits by pre-post comparisons. Provincial government data were used to describe temporal changes in neonatal mortality rates between intervention and non-intervention.

Results: Institutional delivery among indigenous women increased from 35% to 43% in the intervention group while declining from 60% to 54% in the comparison group. Postpartum/postnatal care within 48 hours of birth significantly increased by 54% in the intervention compared with 29% in the comparison group (p=0.03). The project increased community and facility quality of care and maternal knowledge regarding labor, delivery, newborn and post-partum danger signs, and birth preparedness and exclusive breastfeeding , and satisfaction with institutional care (all p≤0.01 or p≤0.001). The intervention parishes experienced a nearly continual decline in newborn mortality between 2009 and 2012 compared with a slight increase in the control parishes (p≥0.001).

Conclusions: The project successfully established a comprehensive, coordinated and sustainable provincial-level EONC network that improved access to, quality, use and provision of essential obstetric and neonatal care and survival. The Ministry of Health in Ecuador is scaling up the model nationally.