Evaluating the Impact of a Quality Improvement Initiative on Active Management of the Third Stage of Labour in Rural Rwandan Health Centres: A Pre-Post Intervention Study

Postpartum haemorrhage remains a leading cause of maternal mortality in sub-Saharan Africa. Active management of the third stage of labour is a proven intervention for its prevention, but consistent delivery in low-resource rural settings is often inadequate. This study evaluated the impact of a structured quality improvement initiative on the proportion of women receiving all three components of active management of the third stage of labour in rural Rwandan health centres. A pre-post intervention study was conducted in a sample of rural health centres. Baseline data on active management practices were collected via direct observation of deliveries. A multifaceted quality improvement initiative, comprising clinical training, mentorship, and the introduction of a simplified partograph with active management prompts, was then implemented. Post-intervention data were collected after a defined period using identical observation methods. The primary outcome was the change in the proportion of deliveries receiving complete active management. Following the initiative, the proportion of deliveries receiving complete active management increased significantly. The pre-intervention rate rose from 42% to 78% post-intervention. Improvements were noted for all three individual components, with administration of uterotonics achieving the highest adherence. A targeted quality improvement initiative incorporating training, mentorship, and job aids was associated with a substantial increase in correct active management of the third stage of labour in this setting. This indicates the potential of such programmes to improve adherence to essential clinical guidelines. Health policymakers should consider integrating similar multifaceted quality improvement strategies into routine maternal health programmes to enhance guideline adherence. Further research should assess the sustainability of improvements and their direct impact on postpartum haemorrhage incidence. postpartum haemorrhage, active management of third stage of labour, quality improvement, maternal health, Rwanda, implementation research This study provides evidence on the effectiveness of a practical quality improvement approach for increasing adherence to a critical maternal health intervention in rural, low-resource health centres.