Quality of medical services provided to mothers, newborns and children at the hospital level in the Kyrgyz Republic

TL;DR

This study evaluates the impact of a WHO quality improvement project on hospital care for mothers, newborns, and children in the Kyrgyz Republic.

Contribution

The study provides empirical evidence on the effectiveness of a WHO quality improvement project in Kyrgyz hospitals.

Findings

The proportion of planned caesarean sections before 39 weeks decreased in intervention hospitals but remained high in control hospitals.

Unnecessary antibiotic prescriptions for newborns and children decreased in intervention hospitals but remained a concern in control hospitals.

Prescription of oral rehydration salts and zinc for children with diarrhoea improved in intervention hospitals during the project period.

Abstract

The Kyrgyz Republic has recently implemented health programmes to improve the quality of care for mothers, newborns and children. To support these efforts, a three-year World Health Organization (WHO) quality improvement (QI) project aimed to strengthen clinical practices and service delivery. This study was conducted to independently assess the project’s effectiveness and inform policy and programming.

Data were collected retrospectively from 18 hospitals: nine that implemented the intervention (IH) and nine control hospitals (CH). Medical records were randomly selected for women in labour, newborns and children hospitalised in 2019, 2021 (pre-QI project), and 2023 (post-QI project).

We reviewed 1707 women’s, 1736 newborns’, and 1593 children’s records. The proportion of women with a planned caesarean section before 39 + 0 weeks of gestation was 44.8% (2021) and 28.3% (2023) in IH, and 53.3% and 50.0%, respectively, in CH. Antibiotic prophylaxis use for caesarean sections was high in both IH and CH. The proportion of newborns breastfed within the first 30 minutes of life in IH was 58.3% (2021), and 50.6% (2023), and in CH 56.6% and 64.1%, respectively. Newborns were unnecessarily prescribed antibiotics in IH (13.7% in 2021, 16.2% in 2023), and in CH (24.2% and 6.1%, respectively). Children were frequently prescribed unnecessary antibiotics both in IH and CH. Children with pneumonia were unnecessarily prescribed corticosteroids both in IH (35.5% in 2019, 54.7% in 2023) and in CH (28.3% in 2019, 50.9% in 2023). The proportion of children with diarrhoea receiving oral rehydration salts (ORS) and zinc increased between the start and the end of the QI project in IH while this was not the case for zinc prescription in CH.

These results highlight the importance of continuous monitoring and targeted interventions to enhance quality care. Routine clinical audits based on medical record reviews should be institutionalised to support hospital managers in enhancing clinical practices.

Figures