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Evaluating the impact of a hospital scale-up phase of a quality improvement intervention in Ghana on mortality for children under five.

OBJECTIVE
To evaluate the scale-up phase of a national quality improvement initiative across hospitals in Southern Ghana.


DESIGN
This evaluation used a comparison of pre- and post-intervention means to assess changes in outcomes over time. Multivariable interrupted time series analyses were performed to determine whether change categories (interventions) tested were associated with improvements in the outcomes.


SETTING
Hospitals in Southern Ghana.


PARTICIPANTS
The data sources were monthly outcome data from intervention hospitals along with program records.


INTERVENTION
The project used a quality improvement approach whereby process failures were identified by health staff and process changes were implemented in hospitals and their corresponding communities. The three change categories were: timely care-seeking, prompt provision of care and adherence to protocols.


MAIN OUTCOME MEASURES
Facility-level neonatal mortality, facility-level postneonatal infant mortality and facility-level postneonatal under-five mortality.


RESULTS
There were significant improvements for two outcomes from the pre-intervention to the post-intervention phase. Postneonatal infant mortality dropped from 44.3 to 21.1 postneonatal infant deaths per 1000 admissions, while postneonatal under-five mortality fell from 23.1 to 11.8 postneonatal under-five deaths per 1000 admissions. The multivariable interrupted time series analysis indicated that over the long-term the prompt provision of care change category was significantly associated with reduced postneonatal under five mortality (β = -0.0024, 95% CI -0.0051, 0.0003, P < 0.10).


CONCLUSIONS
The reduced postneonatal under-five mortality achieved in this project gives support to the promotion of quality improvement as a means to achieve health impacts at scale.