Quality of maternal and newborn care in limited-resource settings: a facility-based cross-sectional study in Burkina Faso and Côte d’Ivoire

OBJECTIVE: To assess and compare the quality of intrapartum and immediate postpartum care across levels of healthcare in Burkina Faso and Côte d’Ivoire using validated process indicators. DESIGN: Health facility-based cross-sectional study with direct observation of healthcare workers’ practices while caring for mother–newborn pairs during intrapartum and immediate postpartum periods. SETTING: Primary healthcare facilities and their corresponding referral hospitals in the Central-North region in Burkina Faso and the Agneby-Tiassa-Mé region in Côte d’Ivoire. PARTICIPANTS: Healthcare providers who care for mother–newborn pairs during intrapartum and immediate postpartum periods, the labouring women and their newborns after childbirth. MAIN OUTCOME MEASURE(S): Adherence to essential best practices (EBPs) at four pause points in each birth event and the overall quality score based on the level of adherence to the set of EBPs observed for a selected pause point. RESULTS: A total of 532 and 627 labouring women were included in Burkina Faso and Côte d’Ivoire, respectively. Overall, the compliance with EBPs was insufficient at all the four pause points, even though it varied widely from one EBP to another. The adherence was very low with respect to hand hygiene practices: the care provider wore sterile gloves for vaginal examination in only 7.96% cases (95% CI 5.66% to 11.06%) in Burkina Faso and the care provider washed hands before examination in 6.71% cases (95% CI 3.94% to 11.20%) in Côte d’Ivoire. The adherence was very high with respect to thermal management of newborns in both countries (>90%). The overall mean quality scores were consistently higher in referral hospitals in Burkina Faso at all pause points excluding immediate post partum. CONCLUSIONS: Women delivering in healthcare facilities do not always receive proven EBPs needed to prevent poor childbirth outcomes. There is a need for quality improvement interventions.