Evaluating The Impact Of A Hospital Scale-Up Phase Of A Quality Improvement Intervention In Ghana On Mortality For Children Under Five

Objective: To evaluate the scale-up phase of a national quality improvement initiative across hospitals in Southern Ghana.Design: This evaluation used a comparison of pre- and post-intervention means to assess changes in outcomes over time. Multivariable interrupted time series analyses were performed to determine whether change categories (interventions) tested were associated with improvements in the outcomes.Setting: Hospitals in Southern GhanaParticipants: The data sources were monthly outcome data from intervention hospitals along with program records.Intervention: The project used a quality improvement approach whereby process failures were identified by health staff and process changes were implemented in hospitals and their corresponding communities. The three change categories were: timely care-seeking, prompt provision of care and adherence to protocols.Main outcome measures: Facility-level neonatal mortality, facility-level postneonatal infant mortality and facility-level postneonatal under-five mortality.Results: There were significant improvements for two outcomes from the pre-intervention to the post-intervention phase. Postneonatal infant mortality dropped from 44.3 to 21.1 postneonatal infant deaths per 1000 admissions, while postneonatal under-five mortality fell from 23.1 to 11.8 postneonatal under-five deaths per 1000 admissions. The multivariable interrupted time series analysis indicated that over the long-term the prompt provision of care change category was significantly associated with reduced postneonatal under five mortality (beta = -0.0024, 95% CI -0.0051, 0.0003, P < 0.10).Conclusions: The reduced postneonatal under-five mortality achieved in this project gives support to the promotion of quality improvement as a means to achieve health impacts at scale.