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March 13, 2026Open Access

Longitudinal Evaluation of Maternal Care Facility Systems and Clinical Outcomes in South Africa: A Randomised Field Trial

Key Points

This study evaluates the impact of a systems-strengthening intervention on maternal and neonatal outcomes in public health facilities.
Conducted a longitudinal, cluster-randomised trial across 42 public maternal care facilities
Facilities received either a multi-component intervention or standard care
Primary outcomes included severe maternal morbidity and neonatal mortality, measured at 28 days postpartum
Data collected from clinical records using a generalized linear mixed model for analysis
The intervention significantly reduced composite adverse outcomes (adjusted odds ratio 0.76, 95% CI 0.62 to 0.93)
Notably, there was a 32% reduction in facility-acquired neonatal sepsis among the intervention group

Abstract

"background": "Maternal healthcare facility systems in sub-Saharan Africa are complex, yet evidence linking specific system-level interventions directly to clinical outcomes from robust, longitudinal designs is scarce. ", "purpose and objectives": "This study aimed to evaluate the causal impact of a structured facility systems-strengthening intervention on maternal and neonatal clinical outcomes within a public health setting. ", "methodology": "A longitudinal, cluster-randomised field trial was conducted across 42 public maternal care facilities. Facilities were randomised to receive the multi-component systems intervention or continue standard care. Primary outcomes were a composite of severe maternal morbidity and neonatal mortality, measured at 28 days postpartum. Data were collected longitudinally from clinical records for a cohort of participants. The primary analysis used a generalised linear mixed model: logit (P (Y{ij=1) ) = \0 + \1 Tj + \ Xij + uj, where Yij is the outcome for individual i in cluster j, Tj is the treatment assignment, Xij are covariates, and uj is a cluster random effect. Robust standard errors were used for inference. ", "findings": "The intervention was associated with a statistically significant reduction in the composite adverse outcome (adjusted odds ratio 0. 76, 95% CI 0. 62 to 0. 93). The most pronounced effect was a 32% reduction in facility-acquired neonatal sepsis among the intervention group. ", "conclusion": "Targeted strengthening of facility-based systems can yield significant improvements in critical clinical outcomes for mothers and newborns. ", "recommendations": "Integration of this systems intervention into national maternal care quality improvement programmes is warranted. Future implementation should prioritise the infection prevention and control components identified as key drivers of the observed effect. ", "key words": "health systems research, maternal health, cluster randomised trial, implementation science, quality of care, sub-Saharan Africa", "contribution statement": "This study provides novel

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Cite This Study

Merwe et al. (Sat,) studied this question.

synapsesocial.com/papers/69b3acb202a1e69014cce923 https://doi.org/https://doi.org/10.5281/zenodo.18948110

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