The effectiveness of the quality improvement collaborative strategy in low- and middle-income countries: A systematic review and meta-analysis
Autoři:
Ezequiel Garcia-Elorrio aff001; Samantha Y. Rowe aff002; Maria E. Teijeiro aff004; Agustín Ciapponi aff005; Alexander K. Rowe aff002
Působiště autorů:
Healthcare quality and safety department, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
aff001; Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
aff002; CDC Foundation, Atlanta, Georgia, United States of America
aff003; Quality Department, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Escobar, Buenos Aires Province, Argentina
aff004; Argentine Cochrane Centre, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
aff005
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0221919
Souhrn
Background
Quality improvement collaboratives (QICs) have been used to improve health care for decades. Evidence on QIC effectiveness has been reported, but systematic reviews to date have little information from low- and middle-income countries (LMICs).
Objective
To assess the effectiveness of QICs in LMICs.
Methods
We conducted a systematic review following Cochrane methods, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for quality of evidence grading, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement for reporting. We searched published and unpublished studies between 1969 and March 2019 from LMICs. We included papers that compared usual practice with QICs alone or combined with other interventions. Pairs of reviewers independently selected and assessed the risk of bias and extracted data of included studies. To estimate strategy effectiveness from a single study comparison, we used the median effect size (MES) in the comparison for outcomes in the same outcome group. The primary analysis evaluated each strategy group with a weighted median and interquartile range (IQR) of MES values. In secondary analyses, standard random-effects meta-analysis was used to estimate the weighted mean MES and 95% confidence interval (CI) of the mean MES of each strategy group. This review is registered with PROSPERO (International Prospective Register of Systematic Reviews): CRD42017078108.
Results
Twenty-nine studies were included; most (21/29, 72.4%) were interrupted time series studies. Evidence quality was generally low to very low. Among studies involving health facility-based health care providers (HCPs), for “QIC only”, effectiveness varied widely across outcome groups and tended to have little effect for patient health outcomes (median MES less than 2 percentage points for percentage and continuous outcomes). For “QIC plus training”, effectiveness might be very high for patient health outcomes (for continuous outcomes, median MES 111.6 percentage points, range: 96.0 to 127.1) and HCP practice outcomes (median MES 52.4 to 63.4 percentage points for continuous and percentage outcomes, respectively). The only study of lay HCPs, which used “QIC plus training”, showed no effect on patient care-seeking behaviors (MES -0.9 percentage points), moderate effects on non-care-seeking patient behaviors (MES 18.7 percentage points), and very large effects on HCP practice outcomes (MES 50.4 percentage points).
Conclusions
The effectiveness of QICs varied considerably in LMICs. QICs combined with other invention components, such as training, tended to be more effective than QICs alone. The low evidence quality and large effect sizes for QIC plus training justify additional high-quality studies assessing this approach in LMICs.
Klíčová slova:
Labor and delivery – HIV diagnosis and management – Systematic reviews – Behavioral and social aspects of health – HIV prevention – Hypertensive disorders in pregnancy
Zdroje
1. The Millennium Development Goals Report 2015. New York: United Nations; 2015.
2. Sachs JD. From millennium development goals to sustainable development goals. Lancet. 2012;379(9832):2206–11. doi: 10.1016/S0140-6736(12)60685-0 22682467
3. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e252. doi: 10.1016/S2214-109X(18)30386-3 30196093
4. Ovretveit J, Bate P, Cleary P, Cretin S, Gustafson D, McInnes K, et al. Quality collaboratives: lessons from research. Quality & Safety in Health Care. 2002;11(4):345–51.
5. Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q. 2013;91(2):354–94. doi: 10.1111/milq.12016 23758514
6. Institute for Healthcare Improvement. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. Cambridge, Massachusetts: Institute for Healthcare Improvement. 2003.
7. Kruk ME, Pate M, Mullan Z. Introducing The Lancet Global Health Commission on High-Quality Health Systems in the SDG Era. Lancet Glob Health. 2017;5(5):e480–e1. doi: 10.1016/S2214-109X(17)30101-8 28302563
8. Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ. 2008;336(7659):1491–4. doi: 10.1136/bmj.39570.749884.BE 18577559
9. de Silva D. Improvement collaboratives in health care. London: Health Foundation, 2014.
10. Wells S, Tamir O, Gray J, Naidoo D, Bekhit M, Goldmann D. Are quality improvement collaboratives effective? A systematic review. BMJ Qual Saf. 2018;27(3):226–40. doi: 10.1136/bmjqs-2017-006926 29055899
11. Rowe AK, Rowe SY, Peters DH, Holloway KA, Chalker J, Ross-Degnan D. Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review. The Lancet Global Health. 2018;6(11):e1163–e75. doi: 10.1016/S2214-109X(18)30398-X 30309799
12. Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Chichester: The Cochrane Collaboration 2011.
13. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. doi: 10.1136/bmj.b2700 19622552
14. Cochrane Effective Practice and Organization of Care (EPOC). What study designs should be included in an EPOC review? EPOC Resources for review authors. 2017 [23 January, 2018]. Available from: http://epoc.cochrane.org/resources/epoc-resources-review-authors
15. World Bank Country and Lending Groups Washington, DC. 2018 [07/01/2018]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.
16. Cochrane Effective Practice and Organization of Care (EPOC). Suggested risk of bias criteria for EPOC reviews. EPOC Resources for review authors. 2017 [updated January 2018]. Available from: http://epoc.cochrane.org/resources/epoc-resources-review-authors.
17. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94 doi: 10.1016/j.jclinepi.2010.04.026 21195583
18. Schünemann H, Brożek J, Guyatt G, Oxman A, (editors). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. 2013 [updated October 2013]. Available from: http://gdt.guidelinedevelopment.org/app/index.html.
19. Harder T, Abu Sin M, Bosch-Capblanch X, Bruno C, de Carvalho Gomes H, Duclos P, et al. Towards a framework for evaluating and grading evidence in public health. Health Policy. 2015;119(6):732–6. doi: 10.1016/j.healthpol.2015.02.010 25863647
20. Schunemann HJ, Cuello C, Akl EA, Mustafa RA, Meerpohl JJ, Thayer K, et al. GRADE guidelines: 18. How ROBINS-I and other tools to assess risk of bias in nonrandomized studies should be used to rate the certainty of a body of evidence. J Clin Epidemiol. 2018.
21. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard‐Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD000259. doi: 10.1002/14651858.CD000259.pub3 22696318
22. Holloway KA, Ivanovska V, Wagner AK, Vialle-Valentin C, D. R-D. Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence. Tropical Medicine and International Health. 2013;18:656–64. doi: 10.1111/tmi.12123 23648177
23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed.). 2003;327(7414), 557–560. doi: 10.1136/bmj.327.7414.557 12958120
24. Hulscher ME, Schouten LM, Grol RP, Buchan H. Determinants of success of quality improvement collaboratives: what does the literature show? BMJ Qual Saf. 2013;22(1):19–31. doi: 10.1136/bmjqs-2011-000651 22879447
25. Magge H, Chilengi R, Jackson EF, Wagenaar BH, Kante AM. Tackling the hard problems: implementation experience and lessons learned in newborn health from the African Health Initiative. BMC health services research. 2017;17(Suppl 3):829. doi: 10.1186/s12913-017-2659-4 29297352
26. Magge H, Garcia-Elorrio E, Liljestrand J, Hirschhorn L, Twum-Danso N, Roder-DeWan S, et al. From Spread to QI Institutionalization: The Adaptation of Improvement Collaborative Design and Aims in LMICs (in press).
27. N’Guessan J, Franco LM, Ackah A, Kouassi V, Gondwe T. Effects of collaborative improvement on PMTCT and ART indicators in Cote d’Ivoire: a comparative study. Bethesda, MD: University Research Co., LLC (URC), 2011.
28. N’Guessan J, Traore V, Boucar M, Ackah A, Dosso Y, Kouassi V, et al. Results from the pilot phase of an ART/PMTCT improvement collaborative in Cote d’Ivoire. Bethesda, MD: University Research Co., LLC (URC), 2011.
29. Chitashvili T, editor Addressing rational use of medication in pediatric patients with respiratory tract infections (RTI) through improvement collaborative in Georgia. Third Global Symposium on Health Systems Research; 2014 30 September to 3 October 2014; Cape Town, South Africa.
30. Chitashvili T. Rationale for improving integrated service delivery: reduced cost and improved care in Georgia. International Journal of Integrated Care. 2015;15(8).
31. Chitashvili T. Scaling Up, sustaining and institutionalizing better health care in Georgia: results and strategic recommendations from USAID support for improving quality of priority clinical conditions during 2012–2015. Technical Report. 2015.
32. Chitashvili T, Cherkezishvili E. Improving quality of care for respiratory tract infections in children: the role of capacity building and coaching in supporting one multi-facility improvement team in Samtredia district, Georgia. Submitted to a journal for publication to Lancet of Infectious Diseases 2017:22.
33. Chitashvili T CE, Broughton E, Chkhaidze I, Shengelia N, Hill K, Massoud MR, Ruadze E. Improving antibiotic prescription practices for pediatric respiratory tract infections in Georgia. Forthcoming (submitted in 2017 for publication to Lancet Infectious Diseases). 2017.
34. USAID. USAID ASSIST Project: Applying Science to Strengthen and Improve Systems (ASSIST) Project. Georgia Country Report FY14. Bethesda, MD: University Research Co., LLC (URC), 2014.
35. Singh K, Speizer I, Handa S, Boadu RO, Atinbire S, Barker PM, et al. Impact evaluation of a quality improvement intervention on maternal and child health outcomes in Northern Ghana: early assessment of a national scale-up project. Int J Qual Health Care. 2013;25(5):477–87. doi: 10.1093/intqhc/mzt054 23925506; PubMed Central PMCID: PMC3888142.
36. Twum-Danso NA, Akanlu GB, Osafo E, Sodzi-Tettey S, Boadu RO, Atinbire S, et al. A nationwide quality improvement project to accelerate Ghana's progress toward Millennium Development Goal Four: design and implementation progress. Int J Qual Health Care. 2012;24(6):601–11. doi: 10.1093/intqhc/mzs060 23118097.
37. Twum-Danso NA, Dasoberi IN, Amenga-Etego IA, Adondiwo A, Kanyoke E, Boadu RO, et al. Using quality improvement methods to test and scale up a new national policy on early post-natal care in Ghana. Health Policy Plan. 2014;29(5):622–32. doi: 10.1093/heapol/czt048 23894073.
38. Cofie LE, Barrington C, Akaligaung A, Reid A, Fried B, Singh K, et al. Integrating community outreach into a quality improvement project to promote maternal and child health in Ghana. Glob Public Health. 2014;9(10):1184–97. doi: 10.1080/17441692.2014.952656 25204848; PubMed Central PMCID: PMC4310571.
39. Singh K, Brodish P, Speizer I, Barker P, Amenga-Etego I, Dasoberi I, et al. Can a quality improvement project impact maternal and child health outcomes at scale in northern Ghana? Health Res Policy Syst. 2016;14(1):45. doi: 10.1186/s12961-016-0115-2 27306769; PubMed Central PMCID: PMC4910198.
40. Afari H, Hirschhorn LR, Michaelis A, Barker P, Sodzi-Tettey S. Quality improvement in emergency obstetric referrals: qualitative study of provider perspectives in Assin North District, Ghana. BMJ Open. 2014;4(5):e005052. doi: 10.1136/bmjopen-2014-005052 24833695; PubMed Central PMCID: PMC4025473.
41. Speizer IS, Story WT, Singh K. Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms. BMC Pregnancy Childbirth. 2014;14:398. doi: 10.1186/s12884-014-0398-7 25427853; PubMed Central PMCID: PMC4247879.
42. Colbourn T, Nambiar B, Bondo A, Makwenda C, Tsetekani E, Makonda-Ridley A, et al. Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial. Int Health. 2013;5(3):180–95. doi: 10.1093/inthealth/iht011 24030269; PubMed Central PMCID: PMC5102328.
43. Colbourn T, Pulkki-Brannstrom AM, Nambiar B, Kim S, Bondo A, Banda L, et al. Cost-effectiveness and affordability of community mobilisation through women's groups and quality improvement in health facilities (MaiKhanda trial) in Malawi. Cost Eff Resour Alloc. 2015;13(1):1. doi: 10.1186/s12962-014-0028-2 25649323; PubMed Central PMCID: PMC4299571.
44. Colbourn T, Nambiar B, Costello A, MaiKhanda A. Final Evaluation Report. The impact of quality improvement at health facilities and community mobilisation by women’s groups on birth outcomes: an effectiveness study in three districts of Malawi. 2013.
45. Barcelo A, Cafiero E, de Boer M, Mesa AE, Lopez MG, Jimenez RA, et al. Using collaborative learning to improve diabetes care and outcomes: the VIDA project. Prim Care Diabetes. 2010;4(3):145–53. doi: 10.1016/j.pcd.2010.04.005 20478753.
46. Crigler L, Boucar M, K. S, Abdou S, Djibrina S, Saley Z. The Human Resources Collaborative: Improving Maternal and Child Care in Niger. Final Report. 2012.
47. USAID. USAID Health Care Improvement Project. Strengthening human resources for health to improve maternal care in Niger's Tahoua region. Bethesda, MD: University Research Co., LLC (URC), 2011.
48. Oyeledun B, Phillips A, Oronsaye F, Alo OD, Shaffer N, Osibo B, et al. The Effect of a Continuous Quality Improvement Intervention on Retention-In-Care at 6 Months Postpartum in a PMTCT Program in Northern Nigeria: Results of a Cluster Randomized Controlled Study. J Acquir Immune Defic Syndr. 2017;75 Suppl 2:S156–S64. doi: 10.1097/QAI.0000000000001363 28498185.
49. Osibo B, Oronsaye F, Alo OD, Phillips A, Becquet R, Shaffer N, et al. Using small tests of change to improve PMTCT services in Northern Nigeria: Experiences from implementation of a continuous quality improvement and breakthrough series program. Journal of Acquired Immune Deficiency Syndromes. 2017;75:S165–S72. doi: 10.1097/QAI.0000000000001369 28498186
50. Oyeledun B, Oronsaye F, Oyelade T, Becquet R, Odoh D, Anyaike C, et al. Increasing retention in care of HIV-positive women in PMTCT services through continuous quality improvement-breakthrough (CQI-BTS) series in primary and secondary health care facilities in Nigeria: a cluster randomized controlled trial. The Lafiyan Jikin Mata Study. J Acquir Immune Defic Syndr. 2014;67 Suppl 2:S125–31. doi: 10.1097/QAI.0000000000000320 25310118.
51. USAID Health Care Improvement Project. The Improvement Collaborative: An Approach to Rapidly Improve Health Care and Scale Up Quality Services. Bethesda, MD: University Research Co., LLC (URC), 2008 June 2008. Report No.
52. Massoud M. Applying modern quality improvement methodology to maternal and child health in Tver Oblast, Russian Federation. QA Brief. 2001;9(2):28–32.
53. Abdallah H, Chernobrovkinam O, Korotkova A, Massoud R, Burkhalter B. Improving the quality of care for women with pregnancy-induced hypertension reduces costs in Tver, Russia. Operations Research Results 2(4). Bethesda, MD: Agency for International Development (USAID), 2002.
54. Ethier K. Developing evidence-based standards for pregnancy-induced hypertension in Russia. Quality Assurance Project Case Study. Bethesda, MD: Agency for International Development (USAID), 2001.
55. Catsambas TT, Franco LM, Gutmann M, Knebel E, Hill P, Lin Y-S, et al. Evaluating health care collaboratives: the experience of the Quality Assurance Project. Bethesda, MD: University Research Co., LLC (URC), 2008.
56. Franco L, Marquez L, Ethier K, Balsara Z, Isenhower W. Results of collaborative improvement: effects on health outcomes and compliance with evidence-based standards in 27 applications in 12 countries. 2009.
57. Franco LM, Marquez L. Effectiveness of collaborative improvement: evidence from 27 applications in 12 less-developed and middle-income countries. BMJ Quality & Safety. 2011;20(8):658–65. doi: 10.1136/bmjqs.2010.044388 21317182.
58. Furth R, Gass R, Kagubare J. Rwanda human resources assessment for HIV/AIDS services scale up: summary report. Operations Research Results. 2006.
59. Ngidi W, Reddy J, Luvuno Z, Rollins N, Barker P, Mate KS. Using a campaign approach among health workers to increase access to antiretroviral therapy for pregnant HIV-infected women in South Africa. J Acquir Immune Defic Syndr. 2013;63(4):e133–9. doi: 10.1097/QAI.0b013e318291827f 23514955.
60. Wittcoff A, Furth R, Nabwire J, Crigler L. Baseline assessment of HIV service provider productivity and efficiency in Uganda. Technical Report. 2010.
61. Jaribu J, Penfold S, Manzi F, Schellenberg J, Pfeiffer C. Improving institutional childbirth services in rural Southern Tanzania: a qualitative study of healthcare workers' perspective. BMJ Open. 2016;6(9):e010317. Epub 2016/09/24. doi: 10.1136/bmjopen-2015-010317 27660313; PubMed Central PMCID: PMC5051329.
62. Jaribu J, Penfold S, Green C, Manzi F, Schellenberg J. Improving Tanzanian childbirth service quality. Int J Health Care Qual Assur. 2018;31(3):190–202. Epub 2018/04/25. doi: 10.1108/IJHCQA-10-2015-0122 29687759; PubMed Central PMCID: PMC5974692.
63. Broughton E, Saley Z, Boucar M, Alagane D, Hill K, Marafa A, et al. Cost-effectiveness of a quality improvement collaborative for obstetric and newborn care in Niger. International Journal of Health Care Quality Assurance. 2013;26(3):250–61. doi: 10.1108/09526861311311436 23729128.
64. Franco L, Webb L. Niger Site Visit Report. Unpublished report prepared for the U.S. Agency for International Development (USAID) by the USAID Health Care Improvement Project and the Quality Assurance Project. 2008.
65. Westercamp N, Staedke S, Hutchinson E, Naiga S, Nabirye C, Taaka L, et al., editors. Effectiveness and sustainability of a collaborative improvement method to increase the quality of routine malaria surveillance data in Kayunga District, Uganda. 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene;; 2017 Nov 5–9; Baltimore, MD.
66. Hutchinson E, Nayiga S, Nabirye C, Taaka L, Westercamp N, Rowe A, et al. Opening the 'Black Box' of collaborative improvement: a qualitative evaluation of a pilot intervention to improve quality of surveillance data in public health centres in Uganda. 2017.
67. Fatuma A. The Republic of Uganda, Kayunga District Local Government: 3-year district development plan, 2010/2011. 2010 Apr 282010.
68. Horwood C, Butler L, Barker P, Phakathi S, Haskins L, Grant M, et al. A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa. Hum Resour Health. 2017;15(1):39. doi: 10.1186/s12960-017-0210-7 28610590; PubMed Central PMCID: PMC5470211.
69. Horwood CM, Youngleson MS, Moses E, Stern AF, Barker PM. Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries. AIDS. 2015;29 Suppl 2:S155–64. doi: 10.1097/QAD.0000000000000716 26102626.
70. Webster PD, Sibanyoni M, Malekutu D, Mate KS, Venter WDF, Barker PM, et al. Using quality improvement to accelerate highly active antiretroviral treatment coverage in South Africa. BMJ Quality and Safety. 2012;21 (4):315–24. doi: 10.1136/bmjqs-2011-000381 22438327.
71. Waiswa P, Manzi F, Mbaruku G, Rowe A, Marx M, Tomson G, et al. Effects of collaborative quality improvement on maternal and newborn health care in Tanzania and Uganda. The Expanded Quality Management Using Information Power (EQUIP) quasi-experimental study. Implementation Science. 2017;(1).
72. Tancred T, Mandu R, Hanson C, Okuga M, Manzi F, Peterson S, et al. How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda. Health Policy Plan. 2018;33(1):e1–e13. doi: 10.1093/heapol/czu070 29304250.
73. Marchant T, Schellenberg J, Peterson S, Manzi F, Waiswa P, Hanson C, et al. The use of continuous surveys to generate and continuously report high quality timely maternal and newborn health data at the district level in Tanzania and Uganda. Implement Sci. 2014;9:112. doi: 10.1186/s13012-014-0112-1 25149316; PubMed Central PMCID: PMC4160540.
74. Hanson C, Waiswa P, Marchant T, Marx M, Manzi F, Mbaruku G, et al. Erratum to: Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda. Implement Sci. 2015;10:152. doi: 10.1186/s13012-015-0343-9 26515014; PubMed Central PMCID: PMC4627429.
75. Hanson C, Waiswa P, Marchant T, Marx M, Manzi F, Mbaruku G, et al. Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda. Implement Sci. 2014;9(1):41. doi: 10.1186/1748-5908-9-41 24690284; PubMed Central PMCID: PMC4230245.
76. Hanson C, Marchant T, Waiswa P, Manzi F, Schellenberg J, Willey B, et al. Overcoming low implementation levels for essential maternal and newborn health interventions: Results from the equip project using systemic quality improvement in Tanzania and Uganda. International Journal of Gynecology and Obstetrics. 2015;131:E331.
77. Baker U, Hassan F, Hanson C, Manzi F, Marchant T, Swartling Peterson S, et al. Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania-A qualitative study of health workers' perspectives. BMC Pregnancy Childbirth. 2017;17(1):55. doi: 10.1186/s12884-017-1230-y 28166745; PubMed Central PMCID: PMC5294891.
78. Tancred T, Manzi F, Schellenberg J, Marchant T. Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania. Qual Health Res. 2017;27(5):738–49. doi: 10.1177/1049732316638831 27022034.
79. The Health Foundation. Process evaluation of community intervention: baseline report on the experiences of women volunteers as women's group facilitators. In: Centre for International Health & Development, Institute of Child Health. UCL (UK)2008. p. 45 p. Report No.: 20080924 (v1.4 Final) WGF Report.
Článok vyšiel v časopise
PLOS One
2019 Číslo 10
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Eliquis (apixaban) nově hrazen ze zdravotního pojištění
Najčítanejšie v tomto čísle
- Correction: Low dose naltrexone: Effects on medication in rheumatoid and seropositive arthritis. A nationwide register-based controlled quasi-experimental before-after study
- Combining CDK4/6 inhibitors ribociclib and palbociclib with cytotoxic agents does not enhance cytotoxicity
- Risk factors associated with IgA vasculitis with nephritis (Henoch–Schönlein purpura nephritis) progressing to unfavorable outcomes: A meta-analysis
- Prevalence of pectus excavatum (PE), pectus carinatum (PC), tracheal hypoplasia, thoracic spine deformities and lateral heart displacement in thoracic radiographs of screw-tailed brachycephalic dogs