CRITERION BASED AUDIT ON MANAGEMENT OF PRETEM BIRTH IN MULAGO NATIONAL REFERRAL HOSPITAL.
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Introduction: Preterm birth is the leading cause of neonatal deaths and the second leading cause of death in children under five after pneumonia. Even for those that do survive, complications due to prematurity impact lot in their quality of life. Evidence suggests that morbidity and mortality can be reduced when interventions are given to the mother before delivery when preterm labor is anticipated. The study aimed at using a CBA to assess the quality of management of preterm birth. Methods: The study was a CBA on pre-term management conducted in Mulago National Referral Labor ward for a six months’ period from September 2018 to March 2019. A total of 360 case files were reviewed mothers whose files had missing data interviewed for clarity. These included 189 in the baseline audit that run from September to December. A two months’ period was taken off to disseminate and discuss the preliminary findings. Recommendations from the discussions such as development of an institutional protocol were implemented. A second audit was done on 171 case files to assess improvement in quality of care. Chi squares were used to compare results for the baseline and the re-audit. Results: There was a 32% increase at 95% CI, p<0.001 in the patients with gestational less than 34 weeks that received Dexamethasone for fetal lung maturity. Also noted was a 27% increase, 95% CI, p<0,001 in the patients gestational ages less than 34 weeks that received Magnesium Sulphate for fetal neuroprotection. A 23% increase in the patients with PPROM that received anti-biotic up from 46% to 69% at 95% CI which was significant at p<0.05. A 14% reduction was noted in patients who were admitted as pre-term and received no intervention. These reduced from 25% in the initial audit to 20% 95% CI which was significant at p>0.05. However, there was no change in the administration of Tocolytic to patients with gestational ages less than 34 weeks with Cervical dilation of <=4cm. This stagnated at 3% in the initial audit and 4% in the second audit as well as no significant change in those who stayed on the ward for >48 hours. Conclusion: The results of this study have shown that criterion based clinical audit is a feasible and acceptable method for evaluating and improving the quality of care in the management of preterm birth. Its use at Mulago National referral labor ward managed to improve quality of care for the pre-term births.