A systematic, standard-based, participatory assessment of a Continuous Quality Improvement project in Kyrgyzstan and Tajikistan: results for maternal care.

Abstract

Background: Maternal health care quality remains challenging in low- and middle-income countries, including Central Asia, where access to effective care is limited. While quality improvement (QI) interventions have been introduced, their impact is rarely evaluated. This study evaluates the effects of a two-year, complex QI intervention to improve maternal health services in Kyrgyzstan and Tajikistan.

Methods: We employed a pre-post intervention design to evaluate improvements in maternal health care quality in 19 hospitals across Kyrgyzstan and Tajikistan. Following an initial assessment, an action plan was developed using a WHO-standardised tool. The study implemented a multi-faceted intervention to improve maternal health. A 0-3 scoring system measured changes over time. No control group was included.

Results: In Kyrgyzstan, significant improvements were observed in caesarean section management (mean (x̄) = 1.9-2.1, P = 0.01), maternal complications management (x̄ = 1.6-1.9, P = 0.01), postpartum haemorrhage management (x̄ = 1.8-2.1, P = 0.03), and preeclampsia management (x̄ = 1.4-1.9, P = 0.01). Changes in hospital support services (x̄ = 1.6-1.8, P = 0.68) and infection control policies (x̄ = 1.6-1.9, P = 0.32) were not statistically significant. In Tajikistan, statistically significant improvements were seen in hospital support services (x̄ = 1.4-2.0, P = 0.01), routine labour and vaginal birth care (x̄ = 1.4-2.0, P = 0.01), infection control policies (x̄ = 1.4-1.8, P = 0.03), maternal complications management (x̄ = 1.5-2.1, P = 0.02), postpartum haemorrhage (x̄ = 1.7-2.1, P = 0.04), and labour progress (x̄ = 1.2-2.1, P = 0.01). However, changes in caesarean section management (x̄ = 1.7-2.3, P = 0.09) and emergency preparedness (x̄ = 1.6-2.3, P = 0.11) did not reach statistical significance.

Conclusions: The WHO-guided participatory approach set benchmarks that improved labour management, obstetric care, infection control, and infrastructure. Expanding such initiatives, especially in underserved areas, is vital to sustain and scale their impact on maternal health.