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.1 Introduction

The
quality of care has remained a global challenge for saving the lives of the
new-borns and improving women’s experiences at birth in the health  facilities where  care begins.(Kirkwood et al., 2013) Every new born action plan
addressed the importance of quality of care for expectant mothers to be
critical for improving maternal and new born health outcomes.(UNICEF, 2017)

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Globally,
there are  over 546/100,000 maternal
deaths(66%) and neonatal deaths accounts for 
45% of the under-five child mortality.(Alkema L, 2015) Studies have  found out that  these deaths 
could be prevented in health facilities 
with improved provision of better QOC.(Devkota et al., 2017, Fagbamigbe
and Idemudia, 2015)

The
World Health Organisation (WHO) published a framework for measuring quality of
maternal and new-born care in facilities that included eight standards. The
critical ones being evidence based practice for routine care and management of
complications, effective communication, respect and preservation of dignity and
emotional support.(WHO, 2016) These were thought to be critical
in reducing the maternal and new-born care by 50% in the health facilities and
improve the experiences of mothers at birth.

Policies
that promote maternal and new born health care have been developed and
integrated within maternal and new born programmes. The plan highlights
emergency care interventions like psychosocial support for the mother and baby,
postnatal care for the baby and monitoring of the baby two times in the first
week after birth. Standard guidelines for best practice have been put in place
by the WHO and the Ministry of Health(MoH) to provide quality standards for new
born care (MoH, 2010). However, studies indicate that approximately 30% of the
steps are performed wrongly or never performed which leads to poor outcomes.(Noor et al., 2014)

The
factors responsible for the poor quality of care can be assessed using the
Donabedian model that describes the structure, process and outcome. For
example; the structure includes facility readiness, which involves presence of
water, electricity, beds, proper hygiene, and disposal of waste, equipment
necessary for the delivery of a baby, skilled personnel and care given to the
baby immediately after birth. The quality in the process of delivery is
relevant, especially the six cleans (clean hands, surface, blade, cord tie,
towel and cloth) that ensure hygienic practices to reduce on the rate of
neonatal sepsis, duration of hospital stay of mother and baby after delivery,
the physician patient communication are important in improving the experiences
of QOC of women at birth.  (Waiswa et al., 2010)

 

 

1.2       Background

In
the low and middle income countries, 3.3 million neonatal deaths occur in the
first four weeks of life which accounts for 41% of under-five mortality and 75%
occur in the first week after birth especially the first day. Quality of care
at birth is vital in improving women’s experiences at birth in the health
facilities 

 

Uganda
has made great progress in improving access to care for women and children
because the life of the baby entirely depends on the care given to the mother
when she is pregnant to the time of delivery. These interventions have been
positive in increasing facility delivery. 
But the QOC has not been patient centred 
in a way the improves women’s experiences at birth.(Afulani et al., 2017) This explains why the maternal
mortality ratio is still high at 336/100,000 live births and neonatal mortality
has stagnated at 27 deaths per 1000 live births in the past five years. (UDHS
2016).

Mityana
general hospital (MGH) is one of the district hospitals that is mandated to
carry out deliveries. It is also estimated to have the highest neonatal
mortality rates  of 96 deaths  compared to its neighbours; that is Nakaseke,
kiboga,Gomba and Butambala. These deaths could be attributed to the poor
quality of care at birth.

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