1. Clinical Case and Discussion Questions
Issue #70 Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries
Clinical Case and Discussion Questions
Created by William E Cayley, Jr
Journal Club Editor
Prevea Family Medicine Residency

2. Quality improvement in global health
You are working as part of a partnership between a university hospital in the UK and a medical school in Africa.
One of the primary goals of the collaboration is finding ways to improve the quality of maternity care.
As a proponent of evidence-based medicine and evidence-based policy, you have been asked to organize a work group to identify priority areas for intervention.

3. Quality improvement in global health
After reviewing input from patients and healthcare professionals, your work group has decided to address three areas of need:
Workforce issues and professional staff recruitment
Professional education
Access to care

4. Quality improvement in global health
In order to start from a foundation of well- studied evidence, you search the Cochrane Library for relevant evidence and find a recent Cochrane Review entitled
Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

5. Questions for discussion
What workforce issues does this review suggest should be considered as priorities for intervention?
What do the results of this review suggest as priority concerns for professional education?
How does this review help in thinking about the priority issues to address in terms of care access?
Do the findings of this review give you any guidance as to what interventions in the above areas should be highest priority?
Does the type of evidence studied (i.e. qualitative research) have any bearing on your confidence in or application of the findings?

6. For additional reading…
Giacomini MK, Cook DJ. Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA Jul 19;284(3): PubMed PMID:
Giacomini MK, Cook DJ. Users' guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group. JAMA Jul 26;284(4): PubMed PMID:
Giacomini MK, Cook DJ. Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA Jul 19;284(3): PubMed PMID:
Giacomini MK, Cook DJ. Users' guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group. JAMA Jul 26;284(4): PubMed PMID:

7. Further information How to cite the Cochrane Review:
Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD DOI: / CD pub2.
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