Maternal and Child Health Hospital – Report 2012 5 years Quality ...muettergesundheit.org/downloads/hospital-report-2012_kano-kaduna-and... · Institute of Quality Assurance in

Supported by The Rotary FoundationAventis Foundation, International Association of Maternal and Neonatal Health (IAMANEH) Health of Kano State and Ministry of Health of

Institute of Quality Assurance Kano State ,

Maternal and Child Health

Hospital

Quality Assurance in

The Rotary Foundation (TRF), Federal Ministry for Economic cooperation and Development nal Association of Maternal and Neonatal Health (IAMANEH)

Ministry of Health of Kaduna State and the Ministry of FCT Abuja

stitute of Quality Assurance in Obstetrics, Kaduna State and FCT Abuja, Nigeria

Maternal and Child Health Hospital – Report 2012

5 years Quality Assurance in Obstetrics

Federal Ministry for Economic cooperation and Development (BMZ), nal Association of Maternal and Neonatal Health (IAMANEH) and the Ministry of

and the Ministry of FCT Abuja

in Obstetrics and FCT Abuja, Nigeria

Obstetrics

Maternal and Child Health Hospital-Report 2012 Institute of Quality Assurance in Obstetrics of Kano State and Kaduna State

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Definition of quality assurance : Quality assurance is a process in which achievable and desirable levels of quality are described, the extent to which there level are achieved is measured, and action to enable them to be reached is taken." Quality assurance is "an assessment of the effectiveness of health care provision, the efforts made to improve care as a result of assessment, combined with an assurance that quality care will be maintained." Objective:

Objective of carrying out an audit is to improve the quality of clinical care. It is done by changing and strengthening many aspects of hospital, practice and administration.

Audit could be medical where scrutiny is done over the medical aspect of the work performed by the doctors. It could be clinical, where scrutiny is done over the work done by all health professionals including the doctors

( Q u a l i t y a s s u r a n c e , o b s t e t r i c a u d i t i n g , r e c o r d s , r e p o r t s , n o r m s , p o l i c i e s , p r o t o c o l s , p r a c t i c e a n d s t a n d a r d s f o r O B G u n i t ( This page was last

updated on 5-04-2010) (www.maternal-health.org/printable/scaling-up/methodology/quality-assurance/indes.html)

Imprint

Editor: Institute of Quality Assurance Ministry of Health of Kano State and Kaduna State

Chairman: Prof. Dr. Hadiza S. Galadanci, MBBS, Msc, FWACS MRCOG, AKTH Kano Deputy Chairman: Dr. Oladapo Shittu, MBBS, FWACS, ABUTH Zaria, Kaduna State Statistician: Sadiq Abdul-Mumin, Amino Kano Teaching Hospital, Kano Chief Midwife: Liyatu Esubihi, Abuja

Consultants: Prof. Dr. Wolfgang Künzel, FRCOG, FEBCOG, Medical advisor and statistics

Prof. Dr. Robert Zinser, Past District Governor (PDG) Rotary International, Shahon of Zazzau

Dr. Manfred Gruhl, MPH Dr. Björn Misselwitz, MPH Institute of Quality Assurance, Hesse Germany

Coordinator Stakeholders: Dr. Kola Ajao Owoka, PDG Senior Advisor: Prof. Dolapo Lufadeju, PDG As of March 2013


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Content:

I. Organization Page

1. The Institute for Quality Assurance: Data collection and evaluation 4 2. Principles of Quality Assurance 4 3. Circle of continuous quality improvements (Quality circle) 4 4. Hospitals participating in Quality Assurance: Map and Hospitals 5-6

II. Quality Assurance in obstetrics

1. Instruments for data collection 7 2. Obstetrical management in 2008 to 2011 7 3. Incidence of maternal and fetal mortality of the hospitals 8-10 4. Influence of interventions on fetal mortality 11-12

5. Associations between post partum haemorrhage, preeclampsia/eclampsia, number of deliveries and maternal mortality 12-14 6. Instruments to tackle the problem of high fetal mortality 15 -16

III. Audit of Kano State and Kaduna State Hospitals 1. Evaluation 17 2. Instruments for auditing 17 - 18 3. Audit of Kaduna and Kano State Hospitals 18 - 19

IV. Clinical profile 20

V. Half yearly checklist 21

VI. Activities

1. Publications: References, Abstracts 22 2. Review meeting – perinatal conferences 23 3. Reports in media and press 24 4. Community dialogues 25


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I. Organization 1. The Institute of Quality Assurance: Data collection and evaluation The Institute is located at the Aminu Kano Teaching Hospital (AKTH) in Kano. Questionnaires with obstetrical data are routinely collected by the chief midwife Zainab M.S Pawa and evaluated according to defined principles by the statistician Sadiq Abdul-Mumin. The data evaluation is supervised by Dr. Hadiza Galadanci and Dr. Oladapo Shittu. The data are regularly presented to the participating hospitals at half year meetings alternating between the Aminu Kano Teaching Hospital in Kano and Amadu Bello University Teaching Hospital Zaria. The data flow takes place according to the graph below:

2. Principles of Quality Assurance Basic principles of Quality Assurance in a hospital are based on three parameters: 1. Quality of infrastructure, 2. Quality of process and 3. Quality of outcome. All three parameters are interdependent and closely connected. Quality of infrastructure comprises the condition of the hospital building: water supply, power supply, hygienic conditions, number of staff and the equipment available. The quality of process is predominantly dependent on a sufficient structure, but also on trained and well functioning experienced personnel and on professional performance. This can be achieved by a continuing evaluation of the results and by benchmarking. The necessary interventions will lead to a spiral of reduction of maternal and infant morbidity and mortality and consequently improvement of quality outcome. 3. Circle of continuous quality improvements (Quality circle)

Kaduna - Hospitals Kano - Hospitals

1

2

3

4

51

2

3

4

5

Questionnaires Questionnaires

Central Institute of

CIQA

Quality Assurance

Create and introduce new

standards

Analyse the

improve-ment

Analyse and discuss the results

Introduce Standards

Quality Circle: Introduction of standards and the continuous analysis of progress will improve the outcome and lead to the definition of new standards

Maternal and ChildInstitute of Quality Assurance

4. Hospitals participating in Quality A Ten hospitals, five from Kano State and five from Kaduna State participate since 2008 in the data collection and quality assurance in obstetrics (red circles). Federal capital territory (FCT) joined in late 2010 and is added into the data collection and quality assurance in 22012.Ondo State and Enugu Statecircle) has shown interest.

Kano State Hospitals Aminu Kano Teaching Hospital General Hospital Gaya General Hospital Sheik JiddahGeneral Hospital Sumaila General Hospital Takai General Hospital Wudil Data Collection KANO STATE: MIDWIFE NAMR: MARYAM RILWAN PHONE No: 07037704481 E-MAIL: [email protected]


4. Hospitals participating in Quality Assurance in obstetrics

from Kano State and five from Kaduna State participate since 2008 in the data collection and quality assurance in obstetrics (red circles). Federal capital territory (FCT) joined in late 2010 and is added into the data collection and quality assurance in 2

and Enugu State (green circle) will join in 2012 and Bauchi State (grey

Hospital (AKTH), Kano

General Hospital Sheik Jiddah Kano

[email protected]

Referral Hospitals Murtala Mohammed Hospital Nassarawa Hospital in

in Obstetrics of Kano State and Kaduna State

5

from Kano State and five from Kaduna State participate since 2008 in the data collection and quality assurance in obstetrics (red circles). Federal capital territory (FCT) joined in late 2010 and is added into the data collection and quality assurance in 2011and

(green circle) will join in 2012 and Bauchi State (grey

Murtala Mohammed Hospital Nassarawa Hospital in


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Kaduna State Hospitals:

Amadu Bello University Teaching Hospital (ABUTH), Zaria General Hospital Birnin Gwari General Hospital Yusuf Dantosho Kaduna General Hospital Kafanchan General Hospital Saminaka Gambo Sawaba Hospital Kofan Gaya Zaria St. Martins de Porres Hospital, Wusasa, of Catholic Diocese of Zaria, Data collection KADUNA STATE: MIDWIFE NAME: HELEN L.M ADAMU PHONE No. 08039107065 E-MAL: [email protected]

FCT Abuja

Gwagwalada University Teaching Hospital Abaji General Hospital Kwali General Hospital Kuje General Hospital Karshi General Hospital Kubwa General Hospital Karshi General Hospital, Data collection by midwife Liyatu Paul Esubihi FCT ABUJA: Chief midwife of the project NAME: Mrs. Liyatu P. Esubihi PHONE No: 08065344897 FCT- Abuja project office E-MAIL: [email protected] Ondo State University of Ife Teaching Hospital General Hospital Ondo State Specialist Hospital Akure General Hospital Owo Basic Health Center Ute General Hospital Iwaro-Oka ONDO STATE: MIDWIFE NAME: JANET OLUWAYEMISI KUDUYO PHONE No: 08034705954 E-MAIL : [email protected]

Referral Hospitals Barau Dikko Hospital Gwamma Awan Hospital

Referral Hospitals Nyanya Hospital Asokoro Hospital Wuse Hospital Maitama Hospital

Referral Hospitals Mother and Child Hospital Akure, Wesley Guild Hospital Ilesha.


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Bauchi State and Enugu State show interest to participate in the quality assurance program in obstetrics in 2013. II. Quality Assurance in obstetrics 1. Instruments for data collection In consideration of the high maternal and infant mortality it was not advisable to use a difficult and comprehensive questionnaire for data collection. The present questionnaire was combined with the introduction of a maternity record book with simple indicators of maternal and child health. The data are routinely collected every month by the chief midwife. The questionnaire comprises the following data:

Information regarding number of antenatal clinic (ANC) visits (new cases and follow up) and abortions. Further information is provided by important indicators of maternal and child health: maternal death and infant death, eclampsia and postpartum haemorrhage. All these indicators will be related to the total number of deliveries which allows comparison of the management and outcome among the hospitals.


2. Obstetrical management in 2008

Fig 1: The graph above shows the results of the2010 and 2011. MMR shows obtained by looking at the graphs

3. Incidence of maternal and

2

2,24

1,63

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jan-jun08

MMR (x 1000)

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26 25 24 23 22 16 15

Deliveries in Kano and Kaduna Hospitals 2008 (n)

Hospital code


stetrical management in 2008 - 2012

shows the results of the key quality indicators shows a continuous fall from 2008 to 2011. More information

obtained by looking at the graphs of individual hospitals.

Incidence of maternal and fetal mortality of the fifteen hospitals

2,24

1,56 1,52

1,131,02

1,161,25

0,51 0,56 0,5

jul-dec08 jan-jun09 jul-dec09 jan-jun10 jul-dec10

Maternal Mortality 2008 to 2011

14 13 12 30 31 32 33 34

Deliveries in Kano and Kaduna Hospitals 2008 - 2011

Deliveries 2011

Deliveries 2010

Deliveries 2009

Deliveries 2008

Fig 2in Kadunahospitals in 2008and FCT hospitals in 2011 The year 202009, yellow for 2010green for 2011. show a considerable variationin the numberThe hospital code represents the various hospitals and guarantees confidentiality of the data collection. Hospital code


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indicators for 2008, 2009, More information can be

hospitals

1,05 1,09

0,350,26

0,16 0,2

jan-jun11 jul-dec11

MMR Kano State

MMR Kaduna State

MMR FCT Abuja

Fig 2: Number of deliveries in Kaduna and Kano hospitals in 2008 to 2011 and FCT hospitals in 2011

The blue columns indicate the year 2008, followed by red for 2009, yellow for 2010 and green for 2011. The hospitals show a considerable variation in the number of deliveries. The hospital code represents the various hospitals and guarantees confidentiality of the data collection.


0,000

1,000

2,000

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26 25 24 23 22 16

MD/100,000

deliveries

hospital code

Maternal Mortality (MD/100,00 deliveries)

0,000

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00,0

00 d

eliv

erie

s

MMR/100,000 deliveries in 2008


15 14 13 12 30 31 32 33 34hospital code

Maternal Mortality (MD/100,00 deliveries)

2008 - 2012

MMR (%) 2011

MMR(%) 2010

MMR(%) 2009

MMR(%) 2008

1500 2000 2500 3000 3500 4000

Deliveries

MMR/100,000 deliveries in 2008 - 2011

MMR 2011

MMR 2010

MMR 2009

MMR 2008


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Fig. 4 : Maternal Mortality Ratio (MD/100 000 live birth) in relation to the number of deliveries in Kaduna, Kano and in 2011 in FCT Abuja State hospitals. It is of significance to recognize that hospitals with low delivery rates have higher MMR. This has however significantly changed from 2008 to 2011

Fig. 3: Maternal mortality ratio (MD /100 000 life birth) in 2008 to 2011 There is a consistent reduction of MMR in all the hospitals from 2008 to 2010 except one. The hospital code represents the various hospitals and guarantees confidentiality of the data collection.


0

5

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26 25 24 23 22 16 15

FMR (%)

hospital code

Fetal Mortality (%) 2008

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R (%

)

Fetal Mortality in relation to Maternal Mortality 2008


15 14 13 12 30 31 32 33 34hospital code

Fetal Mortality (%) 2008 - 2011

FMR 2011FMR 2010FMR 2009FMR 2008

3,0 4,0 5,0 6,0 7,0

MMR (%)

Fetal Mortality in relation to Maternal Mortality 2008 - 2011

FMR/MMR 2011

FMR/MMR 2010

FMR/MMR 2009

FMR/MMR 2008


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Fig. 6 : Fetal mortality ratio (FMR %) in relation to maternal mortality (MD x1000 /100 000 life birth) in 2008 to 2011. There is a strong relationship between the MMR and the FMR showing that high MMR is associated with elevated FMR.

Fig. 5: Fetal Mortality Ratio (%) (FMR) 2008 – 2012 There is a considerable variation over the past five years. In four hospitals there was a decrease in FMR, whereas in the remaining hospitals no improvement could be observed.


4. Influence of interventions on fetal mortality

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CS (%)

hospital code

Caesarean Section (%) 2008

CS(%) 2011CS(%) 2010CS(%) 2009CS(%) 2008

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al M

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lity

(%)

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Fetal Mortality in relation to Caesarean Section 2008


Influence of interventions on fetal mortality

16 15 14 13 12 30 31 32 33 34hospital code

Caesarean Section (%) 2008 - 2011

CS(%) 2011CS(%) 2010CS(%) 2009CS(%) 2008

8 10 12 14 16 18 20

Caesarean Section (%)

Fetal Mortality in relation to Caesarean Section 2008 - 2011

FMR/CS 2011

FMR/CS 2010

FMR/CS 2009

FMR/CS 2008


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Fig. 7 : Caesarean section rate (%) in Kaduna, Kano and FCT Abuja State hospitals. As shown in this figure there is considerable variation in the CS rates in the different hospitals and there is no clear pattern over the four years, but adding FCT Abuja State hospitals in 2011 it is shown very clearly that higher numbers of CS are achieved.

Fig. 8: The relationship between CS-rate and fetal mortality ratio in 2008 to 2011. There exists in 2008 to 2010 the paradoxical observation of increasing FMR with rising CS-rates. It is assumed that in cases of severe complication to the mother a CS has been conducted to save the life of the mother although the fetus is already dead. In 2011 a fall of FMR goes in parallel with rising CS rates.


5.Associations between post partum haemorrhagethe number of deliveries and maternal mortality

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)

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Associations between post partum haemorrhage, preeclampsia/the number of deliveries and maternal mortality

1500 2000 2500 3000 3500 4000

Deliveries

Fetal Mortality (%) 2008 - 2011FMR(%) 2011FMR(%) 2010FMR(%) 2009FMR(%) 2008

15 14 13 12 30 31 32 33 34hospital code

Postpartum haemorrhage (%) 2008 - 2011

PPH (%) 2011

PPH (%) 2010PPH (%) 2009PPH(%) 2008


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preeclampsia/eclampsia,

Fig. 10: The incidence of post partum hemorrhage (PPH) in Kaduna, Kano and FCT Abuja State hospitals. There exists a tremendous variation among the hospitals, especially in hospitals 25 and 24. Further investigations have to clarify this observation. However in 7 hospitals there are fewer cases of PPH in 2011 as compared to 2008, 2009 and 2010.

Fig.9: The relationship between the number of deliveries in a hospital and fetal mortality. It is evident that smaller hospitals with low number of deliveries have the highest frequency of fetal mortality. There has been a slight change over the past four years, i.e. FMR fell in hospitals with lower number of deliveries. (see green correlation curve 2011)


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0,0

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Maternal Mortality in relation to postpartum haemorrhage 2008 - 2011

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MMR/PPH 2009

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Postpartum haemorrhage (%) 2008 - 2011

PPH(%) 2011

PPH(%) 2010

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PPH(%) 2008

Fig. 11: The relation between post partum hemorrhage and maternal mortality. There exists a weak relationship between the rate of PPH (%) and MMR. It is clearly shown, that MMR in relation to PPH fell over the years. This needs further investigation.

Fig. 12: Post partum hemorrhage (PPH%) in relation to the number of deliveries in the hospitals in 2008 to 2011. PPH was highest in hospitals with low delivery rates in 2008 (blue line). In 2011 the incidence of PPH in relation to the number of deliveries fell (green circles). Further investigation have to resolve the causes and problems behind this observation.


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%)

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Eclampsia (%) 2008 - 2011

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Eclampsia (%) 2008 - 2011

Eclampsia(%) 2011

Eclampsia(%) 2010

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Eclampsia(%) 2008


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4000

Fig. 13: Incidence of eclampsia and pre-eclampsia in Kano, Kaduna and FCT Abuja State hospitals in 2008 , 2009, 2010 and 2011 The different incidence in the various hospitals is remarkable. Further analysis shows that those hospitals with high PPH also have high eclampsia rates and high MMR.

Fig. 14: The incidence of eclampsia in relation to the number of deliveries in Kaduna, Kano and FCT Abuja State hospitals in 2008 to 2011. The graph demonstrates the close relationship of eclampsia to the number of deliveries, e.g. the size of the hospital. This interesting observation needs further investigations to find out, why the incidence of eclampsia is elevated in smaller hospitals. There is however an improvement over the past years


6. Instruments to tackle the problem of high fetal mortality

Fig 15: Checking the maternity record book by the chief mi dwife Fig 16: Fetal heart rate observations during labor by FHR doppler and partograph

wolfgang@ kuenzel


6. Instruments to tackle the problem of high fetal mortality

Checking the maternity record book by the chief mi dwife

: Fetal heart rate observations during labor by FHR doppler and partograph

wolfgang@ kuenzel-g iessen.de


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: Fetal heart rate observations during labor by FHR doppler and partograph


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Fig. 17: Partograph and Fetal Heart Rate Doppler : are mandatory instruments to reduce the death of the fetus before and during labor and also in the neonatal period.

Demonstration of the application of the “Pocket Fetal Doppler” during a “Review meeting”.


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III. Audit of hospitals 1. Evaluation: For the evaluation “Score criteria for general status” and “Score criteria for hygiene condition” have been used. Each of the five items: 1. Operating theatre 2. Delivery room 3. Neonatal unit 4. Delivery ward/Antenatal clinic 5. General Conditions have been valued from one (excellent) to six (very poor) (see table 2 Instrument for auditing). The total score ranged according to the points given for each subdivision from minimum five points to maximum thirty points for general status and from five to thirty points for hygiene condition, in total from ten to sixty. The score points were used to correlate a relationship between maternal mortality as the worst outcome of facility management and the score for each hospital.(see Fig. 18 and Fig 19)

2. Instrument for auditing

Score criteria for general status : Score criteria for hygiene condition: Operating theatre:

• Anesthesia Apparatus • Condition of the floor • Operating table • Cleanness of sink • Resuscitation equipment • Cleanness of apparatus • Instruments for operations • Dust distribution • Intubation set • Blood stained equipment • Suction machine • Cleanness of resuscitation equipment • Anti shock garments • Filled suction machines • Oxygen availability • Sterilizing condition • Ambu bags • Blood stained walls • Caesarian section set • Availability of operating shoes • Theatre lamp • Unorganized storage of material • Sterilizer • Cleanliness of record books

Delivery room • Delivery beds • Dust distribution • Delivery instruments • Blood stained delivery beds • Specula • Rusted instruments • Vacuum extractor • Rusted delivery beds • Episiotomy set • Conditions in bowls for sterilizing • Delivery set • Condition of mattresses

Baby scale • Hand disinfection Gloves • Resuscitation units for newborns

Neonatal unit: • Incubator • Dust distribution • Instruments for intubation + resuscitation • Rusted instruments • Baby scale • Condition of mattresses


3. Audit of Kaduna State and Kanoequipment in the facilities and the hygienic condit ion in relation to MMR Fig. 18: Relationship between hygienic rating and maternal mortality ratio (%).were evaluated according to the hygienic state of the operating theatre, delivery room, neonatal unit, obstetrical ward/antenatal clinic and variable factors, such as water supply and others. Each unit was evaluated by a score from 1 (best result) and 6 (worst result). A score of conditions, and 30 was equal to worst conditions for both hygienic conditions. Hospitals with the lowest score of 5 – 20 had in three / 100 000 deliveries and hospitals with the highest score of about year 2009.

Delivery ward/Antenatal clinic:

• Number of beds • Drip system • Mosquito nets • Maternity record book • Ultrasound scanning room• Mother scales • Sphygmomanometer

General Conditions:

• Water supply, bore hole • Electricity (power supply)• Window form and good seal• Generator • Refrigerator • MG-Sulfate • Blood bank availability


and Kano State hospitals regarding the condition of equipment in the facilities and the hygienic condit ion in relation to MMR

: Relationship between hygienic rating and maternal mortality ratio (%).o the hygienic state of the operating theatre, delivery room, neonatal unit,

obstetrical ward/antenatal clinic and variable factors, such as water supply and others. Each unit was evaluated by a score from 1 (best result) and 6 (worst result). A score of 5 was equal with excellent

was equal to worst conditions for both hygienic conditions. Hospitals with the had in three out of four cases the lowest MMR of lower than 10 maternal death

pitals with the highest score of about 20-30 had the highest MMR in the

• Conditions of beds • Dust stained mattresses• Condition of the floor • Availability of mosquito nets

Ultrasound scanning room • Cleanness of ultrasound probes• Dust stained instruments

• Hygiene of sinks

Electricity (power supply) • Hygiene of toilets Window form and good seal • Cobwebs

• Gloves • Aprons • Masks


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hospitals regarding the condition of equipment in the facilities and the hygienic condit ion in relation to MMR

: Relationship between hygienic rating and maternal mortality ratio (%). The hospitals o the hygienic state of the operating theatre, delivery room, neonatal unit,

obstetrical ward/antenatal clinic and variable factors, such as water supply and others. Each unit was was equal with excellent

was equal to worst conditions for both hygienic conditions. Hospitals with the lower than 10 maternal death had the highest MMR in the

Dust stained mattresses

Availability of mosquito nets Cleanness of ultrasound probes Dust stained instruments


Fig 19: Re lationship between the stateMMR. The hygienic conditions are not taken into consideration. A good rating of the equipmentscore values of 10-15 are closely related to a low MMR of about deliveries , whereas high ratings

Fig. 20: Example of a well equipped and functional


lationship between the state of the hospital equipment in the obstetrical facili ty and The hygienic conditions are not taken into consideration. A good rating of the equipment

closely related to a low MMR of about 500 maternal eath per 100 000 of 25 are associated with a high MMR.

Example of a well equipped and functional , clean operating theatre


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of the hospital equipment in the obstetrical facili ty and The hygienic conditions are not taken into consideration. A good rating of the equipment i.e. low

500 maternal eath per 100 000

operating theatre


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IV. Clinical profile 2011

Median Range Reference

(min – max) Hospital * Number of deliveries (n) 1645 (555 - 3350) 323 9 Caesarean section (%) 7.35 (1.01 – 18.89) 18.8 9 Retained placenta (%) 1.09 (0.63 – 5.57) 0.71 Eclampsia/Preeclampsia (%) 6.74 (1.70 – 32.07) 2.28 Post partum haemorrhage (%) 3.30 (1.27 – 17.57) 1.57 Maternal mortality (MD) (pro 100.000 life birth) 230 (0.00 – 2870) 190 Fetal Mortality (%) 5.81 (2.44 – 13.51) 2.44

*The hospital with the lowest MMR and lowest FMR was selected as reference hospital


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V. Half yearly Checklist

Items to be checked 1 2 3 4 5 6

Exc. poor 1. Delivery ward

Maternity record book Delivery beds Availability Oxytocin

Availability Ergometrin

Availability Prostaglandines

Long elbow gloves available

Cleanness of A mbu bags

Ultrasound machine (functioning)

Fetal doppler (functioning) – filled batteries

2. Neonatal unit

Baby scale (functioning)

Resuscitating equipments

3. Operating theatre

Blood stained equipment

Cleanness of suction machine Cleanness of operating theatre

Anaesthesia apparatus (functioning)

Cleanness of operating table Dust – cleanness of the floor Theatre lamp working Resuscitating equipments Autoclave (functioning) Cobwebs

4. Ante and postnatal clinic Availability MG -Sulfate Anti shock garments available Mosquito nets in use

5. Neonatal unit Resuscitating equipments Incubator

6. General conditions Water supply (bore hole, water tank) Power supply, Generator


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VI. Activities 1. Publications and Abstracts Zinser, R.: Rotary Project to reduce maternal Mortality. Women deliver Conference, Ministers’ Forum, October 18-20, London 2007. Künzel, W., H. Galadanci, D. Shittu, M. Gruhl, R. Zinser: A model to reduce maternal mortality and fetal mortality in ten hospitals in Kaduna and Kano State, Nigeria – Continuously conducted quality assurance in obstetrics.(Abstract). International Stillbirth Conference (ISC/NPF) November 5-7, Oslo 2008 Galadanci H, W. Künzel, D. Shittu, M. Gruhl, R. Zinser: Quality Assurance in Obstetrics: A Model to reduce maternal and fetal Mortality and Morbidity in 10 Hospitals in Kano and Kaduna State, Nigeria (Abstract) FIGO World Congress Cape Town , South Africa , October 2009 Shittu, Dolapo, W. Künzel, H. Galadanci, M. Gruhl, R. Zinser, St, Adams. Prevention of obstetric fistula by quality assurance in obstetrics – a model of improved obstetrical service in Kano and Kaduna State (Abstract) ISOFS Conference on obstetric fistula, November 25-27, Nairobi 2009 Adams, S., W. Künzel, H. Galadanci, O. Shittu, M. Gruhl, R. Zinser, Reduktion der mütterlichen Mortalität durch Qualitätssicherung in der Geburtshilfe in Kano und Kaduna State, Nigeria, Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, München 5.-8. Oktober 2010 (Poster-Präsentation) Künzel, W. Quality assurance and audit in obstetric care in Nigeria – a model to guarantee sustainability. RCOG International Newsletter 3, (2010) 16-19 Galadanci , H. W. Künzel, D. Shittu, M. Gruhl, R. Zinser, St. Adams , Obstetric quality assurance to reduce maternal and fetal mortality in Kano and Kaduna State hospitals in Nigeria. Intern. J. Gynecol. Obstetrics 114 (2011) 23-28 Adams, S., W. Künzel, H. Galadanci, O. Shittu, M. Gruhl, R. Zinser, Senkung der mütterlichen und kindlichen Mortalität in Nigeria durch Qualitätssicherung – Ergebnisse eines Pilotprojekts, 25. Deutscher Kongress für Perinatale Medizin der DGPM, Berlin 1.-3, Dezember 2011


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2. Meetings on Maternal and Perinatal audit

� I. Perinatal Conference Zaria August 2008

� II. Perinatal Conference Kano February 2009

� Maternal and Child Health Hospital – Report 2008 Institute of Quality Assurance in Obstetrics Kano State and Kaduna State, Nigeria III.Perinatal Conference in Zaria September 2009

� IV. Perinatal Conference Kano February 2010 � Maternal and Child Health, Hospital – Report 2009

Institute of Quality Assurance in Obstetrics Kano State and Kaduna State, Nigeria

� V. Perinatal conference in Kaduna February 2010

� Maternal and Child Health, Hospital – Report 2010 Institute of Quality Assurance in Obstetrics Kano State and Kaduna State, Nigeria

� VI. Perinatal conference in Kaduna November 2010

� VII Perinatal conference Kaduna March 2011

� Maternal and Child Health, Hospital – Report 2011 Institute of Quality Assurance in Obstetrics Kano State and Kaduna State, Nigeria


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3. Reports in Media and Press

Rotary maternal health project receives royal recognition Matthias Schütt, Rotary International News -- 29 August 2008 Keeping mothers healthy keeps kids healthy too Diana Schoberg, The Rotarian -- December 2008 Rotary‘s Großprojekt in Nigeria - keine Zukunft ohne gesunde Mütter Matthias Schütt, Rotary Magazin 1 | 2008 Warum die Familie Kande verstieß… Preis für frühe Geburten: Gynäkologische Fisteln – Prof. Künzel informierte sich über Hilfsprojekt in Nigeria Giessener Allgemeine, 2008-02-11 “Minütlich stirbt eine Frau im Kindbett” Frankfurter Allgemeine Zeitung 2009, C.P. Müller von der Grün Rotary Project MG 53403 - A model to reduce maternal and fetal mortality and morbidity in 10 hospitals in Kano and Kaduna State, Nigeria Robert Zinser, PDG D1860 (Germany), RI-UN Day 2009 Versorgung braucht Qualität Rotary Magazin Distrikt 1820 Juli 2009 Seite 70 Sterben ohne gelebt zu haben – Das Risiko Schwangerschaft in Nigeria Thomas Kruchem 29.12.2009 Journal Panorama Putting children first, Rotary’s special emphasis for 2008-09 ties in with major UN goals and reinforces work Rotarians are already doing– Brad Webber, Global outlook, A Rotary World Magazine Press supplement Dying without having lived Thomas Kruchem, Rotary Magazine 4/2010 Maternal and Neonatal Health in Northern Nigeria – improvement by quality assurance in obstetrics. Blogging for HNN (Healthy Newborn Network) by Wolfgang Künzel, Sept 22, 2011


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4. Community dialogue Conducted Community Dialogues in the villages adjac ent to the ten selected hospitals in the states of Kano and Kaduna

KANO STATE

NAMES OF FACILITIES NAMES OF VILLAGES

1. GAYA GEN. HOSPTAL

2. WUDIL GEN. HOSPITAL 3. TAKAI NYSC HOSPITAL 4. SUMAILA GEN.HOSPITAL

5. SHIEKH JIDDA

KAWARI ANGUWAR DAWA. DAN KAZA AJIKA. DURBUNDAI FAJEWA. MAGAMA GALA. SARINA RIMIN DADA

KADUNA STATE NAMES OF FACILITIES NAMES OF VILLAGES

1. GAMBO SAWABA ZANA

2. KAFANCHAN GEN. HOSPITAL.

3. BIRNIN GWARIGEN.HOSPITAL.

4. YUSUF DANTSOHO.

5. SAMINAKA GEN. HOSPITAL.

DUTSEN ABBA DAKACE TAKAN GINDA DANGOMA. KUYELLO GAYAM. MAKERA KADUNA SOUTH. KAYARDA DUTSEN ALHAJI.


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Documents

Maternal and Child Health Hospital – Report 2012 5 years Quality ...muettergesundheit.org/downloads/hospital-report-2012_kano-kaduna-and... · Institute of Quality Assurance in