Profiles in Improvement: Reducing Under-5 Mortality in Ghana: Margret Marquart Catholic Hospital

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Members from Margret Marquart Catholic Hospital Quality Improvement Team
Kpando, Volta Region, Ghana
 
Margret Marquart Catholic Hospital, located in Kpando in the Volta Region of Ghana, is one of the nine National Catholic Health Service hospitals that participated in the Wave 3 Improvement Collaborative Network as part of Project Fives Alive!, a multi-year project in Ghana that aims to reduce mortality in children less than five years of age.
 
The staff at the hospital were dismayed when they learned their mortality rate for children under five: 33 per 1,000 admissions. The hospital’s quality improvement team began by reviewing data to identify the major causes of these deaths. They found that the most common causes of deaths in children under-5 — malaria, anemia, and neonatal disease (asphyxia, prematurity) — resulted mostly from two causes: delays in seeking care and delays in clinicians providing appropriate care upon arrival at the hospital. With the full support of the hospital leadership, the team then brainstormed to redesign processes to reduce these deaths.
 
Key changes included:
  • Community education on the importance of seeking care early
  • Triage and fast-tracking: Identifying acutely ill patients and providing prompt treatment
  • Blood bank readiness: Blood donation campaigns amongst the youth and requiring all elective surgery cases to bring two blood donors

 

 
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Results from the team's improvements:

 

Note that the graph shows a baseline of 17.7 under-5 deaths per 1,000 admissions — not the 33 that initially motivated the Kpando team to improve. Hospitals in Wave 3 initially used only admissions as their denominator; using this denominator, Kpando’s baseline was 33 under-5 deaths per 1,000 admissions. Subsequently, it was agreed to add emergency detentions and livebirths to the denominator to be more comprehensive; using the new denominator, Kpando’s baseline went from 33 to 17.7, as shown in the graph.

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To learn more about Project Fives Alive! visit www.fivesalive.org.