Use of Supervision Data to Improve Quality of Care for Malaria in Pregnancy: Experience in Six African Countries.

Malaria in pregnancy (MiP) intervention coverage, especially intermittent preventive treatment in pregnancy (IPTp), lags behind other global malaria indicators. In 2020, across Africa, only 32% of eligible pregnant women received at least three IPTp doses, despite high antenatal care attendance. We conducted a secondary analysis of data collected during Outreach Training and Supportive Supervision visits from 2019 to 2020 to assess quality of care and explore factors contributing to providers' competence in providing IPTp, insecticide-treated nets, malaria case management, and respectful maternity care. Data were collected during observations of provider-patient interactions in six countries (Cameroon, Cote d'Ivoire, Ghana, Kenya, Mali, and Niger). Competency scores (i.e., composite scores of supervisory checklist observations) were calculated across three domains: MiP prevention, MiP treatment, and respectful maternity care. Scores are used to understand drivers of competency, rather than to assess individual health worker performance. Country-specific multilinear regressions were used to assess how competency score was influenced by commodity availability, training, provider gender and cadre, job aid availability, and facility type. Average competency scores varied across countries: prevention (44-90%), treatment (78-90%), and respectful maternity care (53-93%). The relative association of each factor with competency score varied. Commodity availability, training, and access to job aids correlated positively with competency in multiple countries. To improve MiP service quality, equitable access to training opportunities for different cadres, targeted training, and access to job aids and guidelines should be available for providers. Collection and analysis of routine supervision data can support tailored actions to improve quality MiP services.

Nursing documentation of inpatient care in eastern Ghana.

BACKGROUND: Despite the usefulness of a well-documented nursing care record, documentation still has its setbacks and receives varying levels of priority among nurses and other health professionals. However, since the quality and standard of patient care is often measured from retrospective records, it is imperative to examine the practice of nursing care documentation. AIM: The study described in this article examined current practices of nursing care documentation in Ghana. METHOD: By means of multiple sampling strategies, a retrospective approach was used to evaluate 100 patient care records in two hospitals between 1 November and 31 December 2012. FINDINGS: Major findings are that 46% of care given to patients was not recorded in the nursing care records; that nurses' progress notes were not written for 63% of patients after the first day of admission; and that 57% of documentation was not signed by nurses. CONCLUSION AND RECOMMENDATION: The standard of nursing care documentation is not on a par with that in developed countries, partly owing to a lack of guidelines, as well as a persistent shortage of nurses and the limited use of nursing care records. It is recommended that nursing stakeholders use a multidisciplinary approach to develop policies/guidelines on nursing care documentation and provide training opportunities for nurses on effective documentation.