Indicator | BR1 % (n/N) (CI 95%) | BR2 % (n/N) (CI 95%) | MX1 % (n/N) (CI 95%) | MX2 % (n/N) (CI 95%) | MX3 % (n/N) (CI 95%) | MX4 % (n/N) (CI 95%) | MX5 % (n/N) (CI 95%) | P value |
Hospital level | Third level | Second level | Second level | Third level | Second level | Second level | Second level | |
Good practice indicators | ||||||||
Management of antibiotics during labour | 83.3 (189/227) (79.4 to 87.2) | 76.8 (129/168) (72.4 to 81.2) | 6.0 (25/417) (4.0 to 8.0) | 9.9 (13/131) (7.4 to 12.4) | 6.3 (33/524) (4.3 to 8.3) | 6.2 (33/531) (4.2 to 8.2) | 4.9 (26/533) (3.1 to 6.7) | 0.000* |
Management of magnesium sulfate at delivery for preeclampsia/ eclampsia control | 11.7 (23/197) (8.4 to 15.0) | 1.4 (2/142) (0.2 to 2.6) | 0.0 | 12.5 (10/80) (9.7 to 15.3) | 15.2 (7/46) (12.2 to 18.2) | 25.9 (7/27) (22.2 to 29.6) | 12.0 (3/25) (9.3 to 14.7) | 0.000* |
Management of antibiotics in the newborn | 90.2 (37/41) (87.1 to 93.3) | 100 (2/2) – | 80.0 (8/10) (76.6 to 83.4) | 68.2 (30/44) (64.3 to 72.1) | 88.5 (23/26) (86.1 to 91.5) | 67.9 (19/28) (64.0 to 71.8) | 66.7 (10/15) (62.7 to 70.7) | 0.062 |
Partograph opening and filling | 4.2 (15/360) (2.1 to 6.3) | 85.6 (308/360) (82.0 to 90.2) | 94.1 (506/538) (92.1 to 96.1) | 78.4 (424/541) (74.9 to 81.9) | 95.4 (517/542) (93.6 to 97.2) | 83.7 (457/546) (80.6 to 86.8) | 91.9 (496/540) (89.6 to 94.2) | 0.000* |
Resolution of justified caesarean delivery | 90.7 (205/226) (87.7 to 93.7) | 93.3 (126/135) (90.7 to 95.9) | 68.3 (84/123) (64.4 to 72.2) | 47.9 (128/267) (42.7 to 52.1) | 92.4 (171/185) (90.2 to 94.6) | 42.0 (42/100) (37.9 to 46.1) | 50.0 (51/102) (45.8 to 54.2) | 0.000* |
Performed justified instrumented childbirth | 100.0 (1/1) – | 0.0 | 0.0 | 78.8 (26/33) (75.4 to 82.2) | 42.9 (3/7) (38.7 to 47.1) | 0.0 | 0.0 | 0.086 |
Performed justified episiotomy | 22.7 (5/22) (18.4 to 27.0) | 6.5 (2/31) (3.9 to 9.1) | 2.0 (6/297) (0.8 to 3.2) | 30.0 (30/100) (26.1 to 33.9) | 14.8 (4/27) (11.8 to 17.8) | 0.0 | 5.7 (9/158) (3.7 to 7.7) | 0.000* |
Good practices in the women (composite indicator) | 22.1 (398/1800) (17.8 to 26.4) | 33.9 (611/1800) (29.0 to 38.8) | 65.2 (1754/2690) (61.2 to 69.2) | 57.5 (1556/2705) (53.3 to 61.7) | 69.7 (1888/2710) (65.8 to 73.6) | 69.3 (1892/2730) (65.4 to 73.2) | 69.7 (1883/2700) (65.8 to 73.6) | – |
Good practices in newborns (composite indicator) | 26.4 (571/2160) (21.8 to 31.0) | 25.0 (541/2160) (20.5 to 29.5) | 63.8 (2060/3228) (59.7 to 67.9) | 46.5 (1509/3246) (42.3 to 50.7) | 57.7 (1875/3252) (53.5 to 61.9) | 45.8 (1499/3276) (41.6 to 50.0) | 46.0 (1489/3240) (41.8 to 50.2) | – |
Good practices in women and newborns (composite indicator) | 24.5 (969/3960) (20.1 to 28.9) | 29.1 (1152/3960) (24.4 to 33.8) | 64.4 (3814/5918) (60.4 to 68.4) | 51.5 (3065/5951) (47.3 to 55.7) | 63.1 (3763/5962) (59.0 to 67.2) | 56.5 (3391/6006) (52.3 to 60.7) | 56.8 (3372/5940) (52.6 to 61.0) | – |
Health outcomes and adverse events indicators | ||||||||
Incidence of obstetric haemorrhage | 1.9 (7/360) (0.5 to 3.3) | 0.3 (1/360) (0.3 to 0.9) | 4.3 (23/538) (2.6 to 6.0) | 5.2 (28/541) (3.3 to 7.1) | 2.0 (11/542) (0.8 to 3.2) | 2.6 (14/546) (1.3 to 3.9) | 2.8 (15/540) (1.4 to 4.2) | 0.000* |
Incidence of pre-, intra- and postpartum blood pressure disorders | 54.7 (197/360) (49.6 to 59.8) | 39.4 (142/360) (34.4 to 44.4) | 2.8 (15/538) (1.4 to 4.2) | 14.8 (80/541) (11.8 to 17.8) | 8.5 (46/542) (6.2 to 10.8) | 4.9 (27/546) (3.1 to 6.7) | 4.6 (25/540) (2.8 to 6.4) | 0,000* |
Incidence of maternal postpartum infection | 5.0 (18/360) (2.7 to 7.8) | 0.0 | 3.5 (19/538) (1.9 to 5.1) | 10.4 (56/541) (7.8 to 13.0) | 1.3 (7/542) (0.3 to 2.3) | 2.0 (11/546) (0.8 to 3.2) | 2.4 (13/540) (1.1 to 3.7) | 0.000* |
Incidence of neonatal infection | 7.5 (27/360) (4.8 to 10.2) | 0.6 (2/360) (0.2 to 1.4) | 1.3 (7/538) (0.3 to 2.3) | 6.1 (33/541) (4.1 to 8.1) | 3.7 (20/542) (2.1 to 5.3) | 2.2 (12/546) (1.0 to 3.4) | 2.2 (12/540) (1.0 to 3.4) | 0.000* |
Incidence of neonatal asphyxia | 3.6 (13/360) (2.1 to 6.1) | 0.3 (1/360) (0.3 to 0.9) | 7.8 (42/538) (5.5 to 10.1) | 17.4 (94/541) (14.2 to 20.6) | 4.2 (23/542) (2.5 to 5.9) | 6.0 (33/546) (4.0 to 8.0) | 3.0 (16/540) (1.6 to 4.4) | 0.000* |
Percentage of deliveries with caesarean section | 62.8 (226/360) (57.7 to 67.6) | 37.5 (135/360) (32.5 to 42.5) | 23.2 (123/530) (19.6 to 26.8) | 49.4 (267/540) (45.2 to 53.6) | 34.2 (185/541) (30.2 to 38.2) | 18.7 (100/536) (15.4 to 22.0) | 19.1 (102/534) (15.8 to 22.4) | 0.000* |
Percentage of instrumented deliveries | 0.7 (1/134) (0.3 to 1.6) | 0.4 (1/225) (0.3 to 1.1) | 0.0 | 12.1 (33/273) (9.4 to 14.8) | 2.0 (7/356) (0.3 to 3.2) | 0.0 | 0.0 | 0.000* |
Percentage of deliveries with episiotomy | 16.4 (22/134) (12.6 to 20.2) | 13.8 (31/224) (10.2 to 17.4) | 73.0 (297/407) (69.2 to 76.8) | 36.6 (100/273) (32.5 to 40.7) | 7.6 (27/356) (5.4 to 9.8) | 55.3 (241/436) (51.1 to 59.5) | 36.6 (158/432) (32.5 to 40.7) | 0.000* |
Adverse events in women (composite indicator) | 13.3 (48/360) (9.8 to 16.8) | 2.2 (8/360) (0.7 to 3.7) | 3.0 (16/538) (1.6 to 4.4) | 6.3 (34/541) (4.3 to 8.3) | 0.7 (4/542) (0.0 to 1.4) | 1.8 (10/546) (0.7 to 2.9) | 2.0 (11/540) (0.8 to 3.2) | 0.000* |
Adverse events in newborns (composite indicator) | 17.2 (62/360) (13.3 to 21.1) | 2.8 (10/360) (1.1 to 4.5) | 8.7 (47/538) (6.3 to 11.1) | 26.1 (141/541) (22.4 to 29.8) | 7.0 (38/542) (4.9 to 9.1) | 8.8 (48/546) (6.4 to 11.2) | 4.8 (26/540) (3.0 to 6.6) | 0.000* |
Adverse events in women and newborns (composite indicator) | 27.2 (98/360) (22.6 to 31.8) | 4.7 (17/360) (2.5 to 6.9) | 11.2 (60/538) (8.5 to 13.9) | 29.6 (160/541) (25.8 to 33.4) | 7.6 (41/542) (5.4 to 9.8) | 9.7 (53/546) (7.2 to 12.2) | 6.7 (36/540) (4.6 to 8.8) | 0.000* |
Case numbers and the 95% confidence intervals are shown in parentheses.
The case numbers of the composite indicators of good practice are higher than the total number of deliveries evaluated because, in each medical record, up to five good practices are performed for the mother and up to six good practices for the newborn (total of 11 good practices for the mother-child binomial).
The composite indicators were calculated by aggregating the simple good practices and adverse events indicators, which are described in table 1.
* Variable with p<0.001
n, numerator; N, denominator.