New research shows that maternal and infant outcomes are steadily improving at the University Teaching Hospital in Lusaka, Zambia, a hospital with which the University of North Carolina at Chapel Hill Department of Obstetrics and Gynecology has a long-standing partnership.
Bellington Vwalika, professor of obstetrics and gynecology at the University of Zambia School of Medicine and research professor of the obstetrics and gynecology department at UNC, is the lead author of the study. “Maternal and newborn outcomes at a tertiary care hospital in Lusaka, Zambia, 2008-2012” was recently published in International Journal of Gynecology and Obstetrics.
The retrospective study analyzed electronic medical record information from women delivering at the University Teaching Hospital from 2008 to 2012. The team measured trends in several key obstetric and neonatal outcomes over a five-year period.
These data showed a steady decline in the rates of maternal mortality, cesarean delivery and hemorrhage during pregnancy. Admissions to the neonatal intensive care unit also generally declined. The number of stillbirths remained relatively stable, but the team found a rise in five-minute Apgar scores above seven. Scores between seven and nine are normal and a sign that the newborn is in good health.
“We’ve seen a lot of improvements over the years. Most women are now receiving some form of prenatal care from qualified health personnel, and more women are delivering their babies in health facilities assisted by qualified health personnel,” said Vwalika. “We are pleased with these findings, particularly for maternal mortality, but continued work is still needed.”
A number of factors likely contributed to these gains. Over this period, for example, the University of Zambia received funding from the Medical Education Partnership Initiative supported by the U.S. President’s Emergency Plan for AIDS Relief and the National Institutes of Health. From 2010 to 2015, more than $10 million was invested in training health care workers and strengthening medical education systems. This included emergency obstetrics and newborn care training, clinical care audits and standardization of common practices.
Broader government investments in health care infrastructure, including blood bank facilities and ambulances, were also important and likely contributed to these improvements as well.
Ben Chi, professor of obstetrics and gynecology at UNC, said the department was a supporting partner in these activities.
“The quality improvement efforts were developed locally by faculty and staff members,” Chi said. “These results are highly encouraging and show how new resources can go a long way in improving care for women and children.”
The authors conclude that routinely collected data can play a valuable role in ongoing program monitoring and should be used to guide quality improvement activities. However, as Vwalika emphasizes, electronic data capture faces many challenges, particularly in rural and remote settings. The health care system must also be capable of quickly responding to identified bottlenecks and gaps, all areas of emphasis for the Zambian Ministry of Health.
Authors also listed on the paper include Benjamin Chi, Elizabeth Stringer and Jeffrey Stringer, faculty at the obstetrics and gynecology department at UNC. Faculty from the obstetrics and gynecology department continue to work with the University Teaching Hospital to further strengthen health care capacity and improve clinical care.