In India, half of all pregnant women between the ages of 15 and 49 years are anaemic. In Uttar Pradesh (UP), this figure is slightly higher at 51%. Unfortunately, only 5.4% pregnant women received full antenatal care (ANC) (National Family Health Survey 4, 2015–2016). A formative research conducted in UP in 2016 found that only 9% of pregnant women in UP consume the five recommended food groups, as per global recommendations.
Ganesh Shankar Vidyarthi Memorial Medical College Hospital is one of the four high case load tertiary care facilities in Kanpur, UP, with an obstetrics and gynaecology (OBGY) outpatient department (OPD) of 2500–3000 consultations with delivery load of 250–300 deliveries per month and paediatric OPD of approximately 5400–6000 consultations per month. It was identified that pregnant women visiting the OPD for ANC were not receiving maternal nutrition-related services, and anthropometric measurements to assess nutritional status and gestational weight gain were also not done.
The department of OBGY decided to apply the four-step Point of Care Quality Improvement (POCQI) approach using Plan–Do–Study–Act cycle for implementation of the maternal nutrition protocol during ANC.
In April 2019, with the support of A&T, the hospital team applied the POCQI methodology to improve ANC service provision. By the end of 2019, the measurement and recording of anthropometric parameters increased to 84% and 74% for height and weight, respectively, from the baseline of zero. Hb testing increased from 58% to 84% and blood pressure (BP) monitoring from zero to 84%. Maternal nutrition counselling was delivered to 76% of the pregnant women visiting the OPD, which was a significant achievement for a new practice introduced into the system.
The improved practices identified and implemented by the department are being sustained through active engagement of the staff and supportive leadership of the department of OBGY.
- quality improvement
- quality improvement methodologies
- women's health
- healthcare quality improvement
Data availability statement
All data relevent to the study are included in the article or uploaded as supplementary information.
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Twitter @parvisharma, @DrMahtabSingh1
Contributors PKS is responsible for overall content of the work. PKS, SG, VP, TF, KP, NG and SN were responsible for conceptualising the project and providing technical support to the project in terms of applying quality improvement methodology and service protocols. PKS, VP, MS, RP, AD, KP, NG and SN provided the mentoring support to the QI team in identification the problems through applying various tools, applying Plan–Do–Study–Act, etc, and collected the data. PKS, BP, SG, TF and VP analysed data and developed draft manuscripts. All listed authors have contributed significantly in various steps of project, starting from conceptualising, designing the project and in its conduct, compilation, analysis and contributing to the manuscript.
Funding Alive & Thrive is global project, Managed by FHI Solutions, funded by Bill & Melinda Gates Foundation, Grant ID OPP 1135090. Publication of this article is made open access with funding from the Bill and Melinda Gates Foundation.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.