{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T23:08:36Z","timestamp":1765667316765,"version":"3.41.2"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"CNPq - National Council of Technological and Scientific Development Brazil","award":["Process number: 401546\/2014-4"],"award-info":[{"award-number":["Process number: 401546\/2014-4"]}]},{"name":"FAPE - Support Funding for Research and Extension - IMIP - Recife - Pernambuco - Brazil"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Uncontrolled, unblinded, pre\u2013post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching\/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/intqhc\/mzab028","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T20:12:24Z","timestamp":1613851944000},"source":"Crossref","is-referenced-by-count":7,"title":["Quality of maternal and newborn hospital care in Brazil: a quality improvement cycle using the WHO assessment and quality tool"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4741-4628","authenticated-orcid":false,"given":"Emanuelle","family":"Pessa Valente","sequence":"first","affiliation":[{"name":"WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell\u2019Istria 65\/1, Trieste, Friuli Venezia Giulia Region 34137, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Barbone","sequence":"additional","affiliation":[{"name":"Scientific Direction, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell\u2019Istria 65\/1, Trieste, Friuli Venezia Giulia Region 34137, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tereza Rebecca","family":"de Melo E Lima","sequence":"additional","affiliation":[{"name":"Post graduation department, doctorate on integral medicine, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos, 300 - Boa Vista, Recife, Pernambuco 50070-902, Brazil"},{"name":"Medicine course department, Faculdade Pernambucana de Sa\u00fade (FPS), av. Mal. Mascarenhas de Morais, 4861 - Imbiribeira, Recife - Pernambuco 51150-000, Pernambuco, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula Ferdinanda Concei\u00e7\u00e3o","family":"de Mascena Diniz Maia","sequence":"additional","affiliation":[{"name":"Medicine course department, Faculdade Pernambucana de Sa\u00fade (FPS), av. Mal. Mascarenhas de Morais, 4861 - Imbiribeira, Recife - Pernambuco 51150-000, Pernambuco, Brazil"},{"name":"Pediatric department, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universit\u00e0ria, Recife - Pernambuco 50670-901, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Vezzini","sequence":"additional","affiliation":[{"name":"Post graduation department, doctorate on integral medicine, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos, 300 - Boa Vista, Recife, Pernambuco 50070-902, Brazil"},{"name":"Dottorato di Ricerca in Scienze della Riproduzione e dello Sviluppo, Universit\u00e0 degli Studi di Trieste, Piazzale Europa, Trieste 34127, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Tamburlini","sequence":"additional","affiliation":[{"name":"Dottorato di Ricerca in Scienze della Riproduzione e dello Sviluppo, Universit\u00e0 degli Studi di Trieste, Piazzale Europa, Trieste 34127, Italy"},{"name":"Director, Centro per la Salute del Bambino, Via Nocol\u00f2 de Rin, 19, Trieste, Friuli Venezia Giulia Region 34143, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"volume-title":"Quality of Care: A Process for Making Strategic Choices in Health Systems","year":"2006","author":"World Health Organization","key":"2022032516083598900_R1"},{"key":"2022032516083598900_R2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-243.","article-title":"Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review","volume":"14","author":"Mangham-Jefferies","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"2022032516083598900_R3","doi-asserted-by":"publisher","first-page":"e676","DOI":"10.1016\/j.midw.2011.09.003.","article-title":"What is quality in maternal and neonatal health care?","volume":"28","author":"Raven","year":"2012","journal-title":"Midwifery"},{"key":"2022032516083598900_R4","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.1016\/S0140-6736(10)62267-2.","article-title":"Quality, quality, quality: gaps in the continuum of care","volume":"379","author":"Graham","year":"2012","journal-title":"Lancet"},{"key":"2022032516083598900_R5","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.1016\/j.socscimed.2010.08.001.","article-title":"Assessing and understanding quality of care in a labour ward: a pilot study combining clinical and social science perspectives in Gondar, Ethiopia","volume":"71","author":"Pitchforth","year":"2010","journal-title":"Soc Sci Med"},{"key":"2022032516083598900_R6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0083070.","article-title":"Do strategies to improve quality of maternal and child health care in lower and middle-income countries lead to improved outcomes? 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