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Moxon SG, B SS, Penn-Kekana L, Sharma S, Talbott J, Campbell OMR, Freedman L. Evolving narratives on signal functions for monitoring maternal and newborn health services: A meta-narrative inspired review. Soc Sci Med 2024; 352:116980. [PMID: 38820693 DOI: 10.1016/j.socscimed.2024.116980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/16/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
Emergency obstetric care (EmOC) signal functions are a shortlist of key clinical interventions capable of averting deaths from the five main direct causes of maternal mortality; they have been used since 1997 as a part of an EmOC monitoring framework to track the availability of EmOC services in low- and middle-income settings. Their widespread use and proposed adaptation to include other types of care, such as care for newborns, is testimony to their legacy as part of the measurement architecture within reproductive health. Yet, much has changed in the landscape of maternal and newborn health (MNH) since the initial introduction of EmOC signal functions. As part of a project to revise the EmOC monitoring framework, we carried out a meta-narrative inspired review to reflect on how signal functions have been developed and conceptualised over the past two decades, and how different narratives, which have emerged alongside the evolving MNH landscape, have played a role in the conceptualisation of the signal function measurement. We identified three overarching narrative traditions: 1) clinical 2) health systems and 3) human rights, that dominated the discourse and critique around the use of signal functions. Through an iterative synthesis process including 19 final articles selected for the review, we explored patterns of conciliation and areas of contradiction between the three narrative traditions. We summarised five meta-themes around the use of signal functions: i) framing the boundaries; ii) moving beyond clinical capability; iii) capturing the woods versus the trees; iv) grouping signal functions and v) measurement challenges. We intend for this review to contribute to a better understanding of the discourses around signal functions, and to provide insight for the future roles of this monitoring approach for emergency obstetric and newborn care.
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Affiliation(s)
- Sarah G Moxon
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 3HT, UK.
| | | | - Loveday Penn-Kekana
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 3HT, UK.
| | - Sudha Sharma
- CIWEC Hospital and Travel Medicine Center, GPO Box, 12895, Kapurdhara Marg, Kathmandu, Nepal.
| | - Jennifer Talbott
- Averting Maternal Death and Disability (AMDD), Columbia University Mailman School of Public Health, 60 Haven Avenue, Suite B3, New York, NY, 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
| | - Oona M R Campbell
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 3HT, UK.
| | - Lynn Freedman
- Averting Maternal Death and Disability (AMDD), Columbia University Mailman School of Public Health, 60 Haven Avenue, Suite B3, New York, NY, 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
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Bayou NB, Grant L, Riley SC, Bradley EH. Quality of hospital labour and delivery care: A multilevel analysis in Southern Nations and Nationalities People's Region of Ethiopia. PLoS One 2024; 19:e0285058. [PMID: 38889169 PMCID: PMC11185448 DOI: 10.1371/journal.pone.0285058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Ethiopia has one of the highest maternal mortality ratios in Africa. Few have examined the quality of labour and delivery (L&D) care in the country. This study evaluated the quality of routine L&D care and identified patient-level and hospital-level factors associated with the quality of care in a subset of government hospitals. MATERIALS AND METHODS This was a facility-based, cross-sectional study using direct non-participant observation carried out in 2016. All mothers who received routine L&D care services at government hospitals (n = 20) in one of the populous regions of Ethiopia, Southern Nations Nationalities and People's Region (SNNPR), were included. Mixed effects multilevel linear regression modeling was employed in two stages using hospital as a random effect, with quality of L&D care as the outcome and selected patient and hospital characteristics as independent variables. Patient characteristics included woman's age, number of previous births, number of skilled attendants involved in care process, and presence of any danger sign in current pregnancy. Hospital characteristics included teaching hospital status, mean number of attended births in the previous year, number of fulltime skilled attendants in the L&D ward, whether the hospital had offered refresher training on L&D care in the previous 12 months, and the extent to which the hospital met the 2014 Ethiopian Ministry of Health standards regarding to resources available for providing quality of L&D care (measured on a 0-100% scale). These standards pertain to availability of human resource by category and training status, availability of essential drugs, supplies and equipment in L&D ward, availability of laboratory services and safe blood, and availability of essential guidelines for key L&D care processes. RESULTS On average, the hospitals met two-thirds of the standards for L&D care quality, with substantial variation between hospitals (standard deviation 10.9 percentage points). While the highest performing hospital met 91.3% of standards, the lowest performing hospital met only 35.8% of the standards. Hospitals had the highest adherence to standards in the domain of immediate and essential newborn care practices (86.8%), followed by the domain of care during the second and third stages of labour (77.9%). Hospitals scored substantially lower in the domains of active management of third stage of labour (AMTSL) (42.2%), interpersonal communication (47.2%), and initial assessment of the woman in labour (59.6%). We found the quality of L&D care score was significantly higher for women who had a history of any danger sign (β = 5.66; p-value = 0.001) and for women who were cared for at a teaching hospital (β = 12.10; p-value = 0.005). Additionally, hospitals with lower volume and more resources available for L&D care (P-values < 0.01) had higher L&D quality scores. CONCLUSIONS Overall, the quality of L&D care provided to labouring mothers at government hospitals in SNNPR was limited. Lack of adherence to standards in the areas of the critical tasks of initial assessment, AMTSL, interpersonal communication during L&D, and respect for women's preferences are especially concerning. Without greater attention to the quality of L&D care, regardless of how accessible hospital L&D care becomes, maternal and neonatal mortality rates are unlikely to decrease substantially.
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Affiliation(s)
- Negalign B. Bayou
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Liz Grant
- Global Health Academy, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School, The University of Edinburgh, Scotland, United Kingdom
| | - Simon C. Riley
- Centre for Reproductive Health, Edinburgh Medical School, The University of Edinburgh, Scotland, United Kingdom
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Abebaw WA, Wolde HF, Tilahun WM, Gebreegziabher ZA, Teshome DF. Quality of childbirth care and its determinants along the continuum of care among pregnant women who gave birth vaginally in Gondar town public health facility, Northwest Ethiopia, 2022: generalised structural equation modelling. BMJ Open 2024; 14:e073199. [PMID: 38580371 PMCID: PMC11002431 DOI: 10.1136/bmjopen-2023-073199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the quality of childbirth care and its determinants along the continuum of care in Gondar town public health facility in Ethiopia. DESIGN An institution-based, cross-sectional study was employed. Completed data were imported to Stata V.16 for cleaning and analysis. A generalised structural equation model was employed to examine the relationships along the continuum of childbirth care and to determine the factors affecting the quality of childbirth care. SETTING AND PARTICIPANTS This study was conducted among a total of 865 women who delivered in the public health facility of Gondar, Ethiopia, from 19 May to 30 June 2022. RESULTS The study revealed the proportion of good-quality childbirth care during admission, intrapartum and immediate postpartum period was 59% (95% CI 55.7, 62.4), 76.8% (95% CI 73.8, 79.5) and 45% (95% CI 41.7, 48.5), respectively. Postsecondary educational status of mothers (β=0.60, 95% CI 0.16, 1.04) and maternal age of 25-35 (β=0.68, 95% CI 0.33, 1.02) were predictors of quality of care at admission. Referral hospital (β=0.43, 95% CI 0.10, 0.76), presence of guidelines (β=1.36, 95% CI 0.72, 1.99) and provider age of 25-35 (β=0.61, 95% CI 0.12, 1.10) affected the quality of care during the intrapartum period. Urban residence (β=0.52, 95% CI 0.12, 0.93), skilled birth attendant experience (β=0.19, 95% CI 0.11, 0.28) and number of delivery couches (β=-0.29, 95% CI -0.44, -0.13) had significant associations with the quality of childbirth care during the immediate postpartum period. CONCLUSIONS Although our study found improvements in the quality of childbirth care along the continuum compared with previous studies, more workers are needed to alleviate the problem of poor-quality service. Different maternal, provider and facility factors were found to be predictors of the quality of childbirth care.
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Affiliation(s)
| | - Haileab Fekadu Wolde
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | | | - Destaw Fetene Teshome
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Orwa J, Temmerman M, Nyaga L, Mulama K, Luchters S. Health facilities preparedness to deliver maternal and newborn health care in Kilifi and Kisii Counties, Kenya. BMC Health Serv Res 2023; 23:868. [PMID: 37587472 PMCID: PMC10428521 DOI: 10.1186/s12913-023-09884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Health facility preparedness is essential for delivering quality maternal and newborn care, minimizing morbidity and mortality by addressing delays in seeking skilled care, reaching appropriate facilities, and receiving emergency care. A rapid assessment of 23 government health facilities in Kilifi and Kisii counties identified poor maternal and newborn indicators in 16 facilities. The Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project supported these facilities with training, equipment, and referral linkages. This study focuses on facility preparedness of the 16 facilities to deliver maternal and newborn health services, specifically delays two and three at the end of the project implementation. METHODS A descriptive cross-sectional study was carried-out on behalf of AQCESS project team by respective county ministry of health in-charge of reproductive maternal newborn and child health programs and trained nurses and medical doctors from Aga Khan health services in December 2019. The study evaluated the accessibility and reliability of drugs, commodities, equipment, personnel, basic necessities (such as water and electricity), and guidelines using validated World Health Organization service availability and readiness assessment tool. The findings of the assessment are presented through frequency and percentage analysis, along with a comparative analysis between the two counties. RESULTS All the 16 facilities assessed offered routine antenatal care (ANC) and normal delivery, but only two provided comprehensive emergency obstetric and newborn care (CEmONC). Most essential medicines, commodities, and required equipment were available. BEmONC and CEmONC guidelines were present in Kilifi, not in Kisii. One staff member was available 24/7 for cesarean section (CS) in each county, with one anesthetist in Kilifi. Electricity was accessible in all facilities, but only half had secondary power supply. Facilities offering CS had backup generators. CONCLUSION The Facilities assessed had necessary drugs, commodities, equipment, and requirements, but staffing and guidelines were limited. Kilifi outperformed Kisii in most indicators. Additional support is needed for infrastructure and human resources to deliver quality maternal and newborn health services. Continuous monitoring will facilitate resource allocation based on facility needs.
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Affiliation(s)
- James Orwa
- Department of Population Health Sciences, Aga Khan University Kenya, P.O. Box 30270, Nairobi, 00100, Kenya.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Lucy Nyaga
- Aga Khan Health Services, Mombasa, Kenya
| | | | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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McCarthy KJ, Blanc AK, Warren CE, Bajracharya A, Bellows B. Exploring the accuracy of self-reported maternal and newborn care in select studies from low and middle-income country settings: do respondent and facility characteristics affect measurement? BMC Pregnancy Childbirth 2023; 23:448. [PMID: 37328744 DOI: 10.1186/s12884-023-05755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Accurate data on the receipt of essential maternal and newborn health interventions is necessary to interpret and address gaps in effective coverage. Validation results of commonly used content and quality of care indicators routinely implemented in international survey programs vary across settings. We assessed how respondent and facility characteristics influenced the accuracy of women's recall of interventions received in the antenatal and postnatal periods. METHODS We synthesized reporting accuracy using data from a known sample of validation studies conducted in Sub-Saharan Africa and Southeast Asia, which assessed the validity of women's self-report of received antenatal care (ANC) (N = 3 studies, 3,169 participants) and postnatal care (PNC) (N = 5 studies, 2,462 participants) compared to direct observation. For each study, indicator sensitivity and specificity are presented with 95% confidence intervals. Univariate fixed effects and bivariate random effects models were used to examine whether respondent characteristics (e.g., age group, parity, education level), facility quality, or intervention coverage level influenced the accuracy of women's recall of whether interventions were received. RESULTS Intervention coverage was associated with reporting accuracy across studies for the majority (9 of 12) of PNC indicators. Increasing intervention coverage was associated with poorer specificity for 8 indicators and improved sensitivity for 6 indicators. Reporting accuracy for ANC or PNC indicators did not consistently differ by any other respondent or facility characteristic. CONCLUSIONS High intervention coverage may contribute to higher false positive reporting (poorer specificity) among women who receive facility-based maternal and newborn care while low intervention coverage may contribute to false negative reporting (lower sensitivity). While replication in other country and facility settings is warranted, results suggest that monitoring efforts should consider the context of care when interpreting national estimates of intervention coverage.
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Affiliation(s)
- Katharine J McCarthy
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Blavatnik Women's Health Research Institute, New York, NY, USA.
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Ayawine A, Atinga RA. “We know it is not good, but we are constrained”: A study on quality of emergency obstetric and newborn care in Northern Ghana. Heliyon 2023; 9:e15250. [PMID: 37095927 PMCID: PMC10121449 DOI: 10.1016/j.heliyon.2023.e15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Objective To explore the quality of emergency obstetric and newborn care provided to newly delivered women in rural Ghana. Methods A multiple case study design, involving in-depth face to face interviews, was deployed to draw evidence from essential health providers, clients and caretakers. Data were further derived from non-participant observation by means of an observation guide and analysis of physical artifacts using the room-by-room walk-through tool. Data analysis followed Yin's five phase process to case study analysis. Results Quality of care was compromised by non-adherence to standard practices, inadequate monitoring, crude treatment procedures, lack of basic care needs and poor health providers' relational behaviours. Limited supplies of drugs, equipment and essential care providers further weakened the provision of quality emergency obstetric and newborn care. Conclusion Inadequate supply of essential logistics and skill gaps on the part of health providers in some maternal and newborn care components adversely produced poor maternal and neonatal outcomes in rural Ghana. Elements of disrespectful care for women suggest violations of their rights in the maternal and newborn care encounter.
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Affiliation(s)
- Alice Ayawine
- School of Public Health and Allied Sciences, Catholic University of Ghana, Fiapre-Sunyani, Ghana
- Corresponding author.
| | - Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Sialubanje C, Kaiser JL, Ngoma T, Mwananyanda L, Fong RM, Hamer DH, Scott NA. Postnatal care services in rural Zambia: a qualitative exploration of user, provider, and community perspectives on quality of care. BMC Pregnancy Childbirth 2023; 23:39. [PMID: 36653751 PMCID: PMC9847069 DOI: 10.1186/s12884-023-05350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) is an important set of services offered to the mother and her newborn baby immediately after birth for the first six weeks to prevent maternal and neonatal complications and death. This qualitative study explored user and provider perspectives on quality of PNC services in the selected health facilities within the context of the Maternity Homes Access in Zambia project in the Saving Mothers Giving Life districts in rural Zambia. METHODS Between October 2018 and February 2019, forty focus group discussions (FGDs) (n = 160 participants) and twelve in-depth interviews (IDIs) were conducted in four districts in Southern and Eastern provinces. FGDs comprised women who delivered within the last year, fathers, community elders, and volunteers. IDIs comprised health workers at facility, district, and provincial levels. Data were analysed using content analysis guided by the international quality of care domains derived from the World Health Organization quality of care framework. Findings were triangulated to understand perceptions. RESULTS Overall, study participants perceived PNC services to be beneficial. Nevertheless, respondents had mixed feelings on the quality of PNC services and expressed a stark difference in their perception of factors affecting service quality. Service users described challenges arising from ineffective communication about the new PNC guidelines, and non-adherence of service providers to quality standards regarding respect, preservation of dignity and emotional support. Other factors were long waiting hours, small examination rooms providing inadequate privacy, and low levels of confidentiality. In contrast, service providers attributed poor service quality to various health system-related factors including low staffing levels, dysfunctional referral services, low supply of essential medicines, supplies, vaccines and equipment for optimal routine emergency obstetric and newborn care and management of complications. CONCLUSION These findings highlight important intervention opportunities to improve quality of PNC services in Zambia through better communication and raising awareness on PNC guidelines, respect, preservation of dignity and emotional support to mothers. Interventions should also focus on addressing contextual health system challenges including staffing levels, supply chain for essential medicines and commodities, shortening waiting time, and ensuring functional referral system.
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Affiliation(s)
- Cephas Sialubanje
- grid.513520.00000 0004 9286 1317School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Jeanette L. Kaiser
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - Thandiwe Ngoma
- grid.511971.aDepartment of Research, Right to Care Zambia, Lusaka, Zambia
| | | | - Rachel M. Fong
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - Davidson H. Hamer
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA ,grid.189504.10000 0004 1936 7558Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA 02118 USA
| | - Nancy A. Scott
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA
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Determinants of Maternal Satisfaction with the Quality of Childbirth Services in a University Hospital in Kumasi, Ghana: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2022. [DOI: 10.1155/2022/9984113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction. Rendering quality childbirth services that lead to higher levels of maternal satisfaction is an important goal of every health institution. Despite efforts at enhanced client satisfaction over the years, there are still some quality concerns for health policymakers and managers to address. This study sought to assess maternal satisfaction with childbirth services at a university hospital in Kumasi, Ghana. Methods. We conducted a facility-based cross-sectional study among women in postnatal wards after delivery at the University Hospital, Kwame Nkrumah University of Science and Technology. They were recruited using a systematic sampling method, and their perspective about the quality of childbirth services was assessed using a service quality (SERVQUAL) tool. Linear regression analysis was performed to identify the relationship between SERVQUAL attributes and maternal satisfaction. Statistical significance was set at
value < 0.05 at a 95% confidence interval. Results. Of the 277 participants interviewed, 79.8% (221) were satisfied with the childbirth services. Delays (49.5%), unprofessional conduct from health workers (7.2%), poor facilities (10.8%), and an inadequate number of skilled staff (15.5%) were identified as the challenges mothers encountered at the facility. After adjusting for all the components of the SERVQUAL model, reliability (adjusted
,
) and empathy (adjusted
,
) were the most significant predictors of maternal satisfaction with childbirth services. Conclusion. Majority of postnatal women were generally satisfied with the overall childbirth services they received at the University Hospital. The service quality components that significantly predicted maternal satisfaction with childbirth services were “reliability” and “empathy.”
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Rahman MA, Kundu S, Rashid HO, Shanto HH, Rahman MM, Khan B, Howlader MH, Islam MA. Socioeconomic inequalities in utilizing facility delivery in Bangladesh: A decomposition analysis using nationwide 2017-2018 demographic and health survey data. PLoS One 2022; 17:e0278093. [PMID: 36441796 PMCID: PMC9704681 DOI: 10.1371/journal.pone.0278093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In many low- and middle-income countries (LMICs), including Bangladesh, socioeconomic inequalities in access to maternity care remain a substantial public health concern. Due to the paucity of research, we attempted to determine the factors affecting the facility delivery, quantify wealth-related inequality, and identify potential components that could explain the inequality. METHODS We used the latest Bangladesh Demographic and Health Survey (BDHS 2017-18) data in this study. We utilized logistic regression to investigate the associated factors of facility delivery. The concentration curves (CC), concentration index (CIX) and decomposition of CIX techniques were used to analyze the inequality in-facility delivery. RESULTS Women living in the urban areas, age at first birth after (18-24 years ≥25 years), being overweight/obese, having secondary and higher-level education of the women and their husband, seeking four or more ANC, coming from more affluent households, and women with high enlightenment were significant determinants of facility delivery. The concentration curve was below the line of equality, and the relative concentration index (CIX) was 0.205 (p <0.001), indicating that women from wealthy groups were disproportionately more prevalent to facility delivery. The decomposition analysis reveals that wealth status of women (57.40%), age at first birth (10.24%), husband's education (8.96%), husband's occupation (7.35%), education of women (7.13%), women's enlightenment (6.15%), residence (8.64%) and ANC visit (6.84%) are the most major contributors to the inequalities in utilizing facility delivery. CONCLUSION The study demonstrates a clear disparity in the use of facility delivery among Bangladeshi women; hence, immediate action is required to lower the inequalities, with a special emphasis on the contributing factors.
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Affiliation(s)
- Md. Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
- * E-mail:
| | - Satyajit Kundu
- Global Health Institute, North South University, Dhaka, Bangladesh
- School of Public Health, Southeast University, Nanjing, China
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Harun Or Rashid
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | | | - Bayezid Khan
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Md. Hasan Howlader
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
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Ferede Gebremedhin A, Dawson A, Hayen A. Evaluations of effective coverage of maternal and child health services: A systematic review. Health Policy Plan 2022; 37:895-914. [PMID: 35459943 PMCID: PMC9347022 DOI: 10.1093/heapol/czac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 03/25/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022] Open
Abstract
Conventionally used coverage measures do not reflect the quality of care. Effective coverage (EC) assesses the extent to which health care services deliver potential health gains to the population by integrating concepts of utilization, need and quality. We aimed to conduct a systematic review of studies evaluating EC of maternal and child health services, quality measurement strategies and disparities across wealth quantiles. A systematic search was performed in six electronic databases [MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, Web of Science and Maternity and Infant Care] and grey literature. We also undertook a hand search of references. We developed search terms having no restrictions based on publication period, country or language. We included studies which reported EC estimates based on the World Health Organization framework of measuring EC. Twenty-seven studies, all from low- and middle-income settings (49 countries), met the criteria and were included in the narrative synthesis of the results. Maternal and child health intervention(s) and programme(s) were assessed either at an individual level or as an aggregated measure of health system performance or both. The EC ranged from 0% for post-partum care to 95% for breastfeeding. When crude coverage measures were adjusted to account for the quality of care, the EC values turned lower. The gap between crude coverage and EC was as high as 86%, and it signified a low quality of care. The assessment of the quality of care addressed structural, process and outcome domains individually or combined. The wealthiest 20% had higher EC of services than the poorest 20%, an inequitable distribution of coverage. More efforts are needed to improve the quality of maternal and child health services and to eliminate the disparities. Moreover, considering multiple dimensions of quality and the use of standard measurements are recommended to monitor coverage effectively.
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Affiliation(s)
- Aster Ferede Gebremedhin
- Department of Public Health, College of Health Sciences, Debre Markos University, PO Box 269, Debre Markos, Ethiopia
- School of Public Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia
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McCauley H, Lowe K, Furtado N, Mangiaterra V, van den Broek N. Essential components of postnatal care - a systematic literature review and development of signal functions to guide monitoring and evaluation. BMC Pregnancy Childbirth 2022; 22:448. [PMID: 35643432 PMCID: PMC9148465 DOI: 10.1186/s12884-022-04752-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postnatal Care (PNC) is one of the healthcare-packages in the continuum of care for mothers and children that needs to be in place to reduce global maternal and perinatal mortality and morbidity. We sought to identify the essential components of PNC and develop signal functions to reflect these which can be used for the monitoring and evaluation of availability and quality of PNC. METHODS Systematic review of the literature using MESH headings for databases (Cinahl, Cochrane, Global Health, Medline, PubMed, and Web of Science). Papers and reports on content of PNC published from 2000-2020 were included. Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders. RESULTS Forty-Eight papers and reports are included in the systematic review from which 22 essential components of PNC were extracted and used to develop 14 signal functions. Signal functions are used in obstetrics to denote a list of interventions that address major causes of maternal and perinatal morbidity or mortality. For each signal function we identified the equipment, medication and consumables required for implementation. The prevention and management of infectious diseases (malaria, HIV, tuberculosis) are considered essential components of routine PNC depending on population disease burden or whether the population is considered at risk. Screening and management of pre-eclampsia, maternal anaemia and mental health are recommended universally. Promotion of and support of exclusive breastfeeding and uptake of a modern contraceptive method are also considered essential components of PNC. For the new-born baby, cord care, monitoring of growth and development, screening for congenital disease and commencing vaccinations are considered essential signal functions. Screening for gender-based violence (GBV) including intimate partner- violence (IPV) is recommended when counselling can be provided and/or a referral pathway is in place. Debriefing following birth (complicated or un-complicated) was agreed through consensus-building as an important component of PNC. CONCLUSIONS Signal functions were developed which can be used for monitoring and evaluation of content and quality of PNC. Country adaptation and validation is recommended and further work is needed to examine if the proposed signal functions can serve as a useful monitoring and evaluation tool. TRIAL REGISTRATION The systematic review protocol was registered: PROSPERO 2018 CRD42018107054 .
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Affiliation(s)
- Hannah McCauley
- Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA UK
| | - Kirsty Lowe
- Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA UK
| | - Nicholas Furtado
- The Global Fund for Aids Tuberculosis and Malaria, Switzerland Geneva
| | - Viviana Mangiaterra
- The Global Fund for Aids Tuberculosis and Malaria, Switzerland Geneva
- Bocconi School of Management, Bocconi University, Milan, Italy
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12
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Exley J, Gupta PA, Schellenberg J, Strong KL, Requejo JH, Moller AB, Moran AC, Marchant T. A rapid systematic review and evidence synthesis of effective coverage measures and cascades for childbirth, newborn and child health in low- and middle-income countries. J Glob Health 2022; 12:04001. [PMID: 35136594 PMCID: PMC8801924 DOI: 10.7189/jogh.12.04001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective coverage measures aim to estimate the proportion of a population in need of a service that received a positive health outcome. In 2020, the Effective Coverage Think Tank Group recommended using a 'coverage cascade' for maternal, newborn, child and adolescent health and nutrition (MNCAHN), which organises components of effective coverage in a stepwise fashion, with each step accounting for different aspects of quality of care (QoC), applied at the population level. The cascade outlines six steps that increase the likelihood that the population in need experience the intended health benefit: 1) the population in need (target population) who contact a health service; 2) that has the inputs available to deliver the service; 3) who receive the health service; 4) according to quality standards; 5) and adhere to prescribed medication(s) or health workers instructions; and 6) experience the expected health outcome. We examined how effective coverage of life-saving interventions from childbirth to children aged nine has been defined and assessed which steps of the cascade are captured by existing measures. METHODS We undertook a rapid systematic review. Seven scientific literature databases were searched covering the period from May 1, 2017 to July, 8 2021. Reference lists from reviews published in 2018 and 2019 were examined to identify studies published prior to May 2017. Eligible studies reported population-level contact coverage measures adjusted for at least one dimension of QoC. RESULTS Based on these two search approaches this review includes literature published from 2010 to 2021. From 16 662 records reviewed, 33 studies were included, reporting 64 effective coverage measures. The most frequently examined measures were for childbirth and immediate newborn care (n = 24). No studies examined measures among children aged five to nine years. Definitions of effective coverage varied across studies. Key sources of variability included (i) whether a single effective coverage measure was reported for a package of interventions or separate measures were calculated for each intervention; (ii) the number and type of coverage cascade steps applied to adjust for QoC; and (iii) the individual items included in the effective coverage definition and the methods used to generate a composite quality measure. CONCLUSION In the MNCAHN literature there is substantial heterogeneity in both definitions and construction of effective coverage, limiting the comparability of measures over time and place. Current measurement approaches are not closely aligned with the proposed cascade. For widespread adoption, there is a need for greater standardisation of indicator definitions and transparency in reporting, so governments can use these measures to improve investments in MNACHN and implement life-saving health policies and programs.
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Affiliation(s)
- Josephine Exley
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Prateek Anand Gupta
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jennifer Harris Requejo
- Division of Data, Analytics, Planning & Monitoring, United Nations Children’s Fund, New York, USA
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Child Health Accountability Tracking Technical Advisory Group (CHAT) and the Mother and Newborn Information for Tracking Outcomes and Results Technical Advisory Group (MoNITOR)
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
- Division of Data, Analytics, Planning & Monitoring, United Nations Children’s Fund, New York, USA
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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13
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Adegbosin AE, Warnken J, Sun J. Mapping the quality of basic and comprehensive emergency obstetric care services in Haiti. Int J Qual Health Care 2021; 33:6406584. [PMID: 34669936 DOI: 10.1093/intqhc/mzab143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/14/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate geographical inequalities and changes in the quality of emergency obstetric care services available in Haiti over time. METHODS We utilized data from the Service Provision Assessment survey of all health facilities in Haiti in 2013 and 2017.We developed a quality index for basic emergency obstetric care (BEmOC) and comprehensive emergency obstetric care (CEmOC) based on the items in the signal functions of an emergency obstetric care framework, using a structure, process and outcome framework. We measured the quality index of all facilities in 2013 and 2017. We also assessed geographical trends and changes in quality between 2013 and 2017 using geospatial analysis. RESULT Our analysis showed that basic structure items such as connection to electricity grid, manual vacuum extractors, vacuum aspirators and dilation and curettage kits were widely unavailable at healthcare facilities. There was a significant improvement in indicators of structure (P < 0.001) and BEmOC (P = 0.03) in primary facilities; however, there was no significant change in the quality of CEmOC in primary facilities (P = 0.18). Similarly, there was no significant change in any of the structure or process indicators at secondary care facilities. CONCLUSION The availability of BEmOC at several Haitian facilities remains poor; however, there was significant improvement at primary care facilities, with little to no change in overall quality at secondary health facilities.
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Affiliation(s)
- Adeyinka E Adegbosin
- School of Medicine, Griffith University, G40, Parklands drive, Southport, QLD 4222, Australia
| | - Jan Warnken
- School of Environment and Science, Griffith University, G24, Parklands drive, Southport, QLD 4222, Australia
| | - Jing Sun
- School of Medicine, Griffith University, G40, Parklands drive, Southport, QLD 4222, Australia
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Kolekang A, Sarfo B, Danso-Appiah A, Dwomoh D, Akweongo P. Are maternal and child health initiatives helping to reduce under-five mortality in Ghana? Results of a quasi-experimental study using coarsened exact matching. BMC Pediatr 2021; 21:473. [PMID: 34696760 PMCID: PMC8547109 DOI: 10.1186/s12887-021-02934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a 53 % decline in under-five mortality (U5M) worldwide during the period of the Millennium Development Goals (MDGs), U5M remains a challenge. Under-five mortality decline in Ghana is slow and not parallel with the level of coverage of child health interventions. The interventions promoted to improve child survival include early initiation of breastfeeding, clean postnatal care, and skilled delivery. This study sought to assess the effectiveness of these interventions on U5M in Ghana. METHODS A quasi-experimental study was conducted using secondary data of the 2008 and 2014 Ghana Demographic and Health Surveys. Coarsened Exact Matching and logistic regression were done. The interventions assessed were iron intake, early initiation of breastfeeding, clean postnatal care, hygienic disposal of stool, antenatal care visits, skilled delivery, intermittent preventive treatment of malaria in pregnancy, and tetanus toxoid vaccine. RESULTS There were 2,045 children under-five years and 40 (1.9 %) deaths in 2008. In 2014, the total number of children under-five years was 4,053, while deaths were 53(1.2 %). In 2014, children less than one month old formed 1.6 % of all children under-five years, but 47.8 % of those who died. Mothers who attended four or more antenatal care visits were 78.2 % in 2008 and 87.0 % in 2014. Coverage levels of improved sanitation and water connection in the home were among the lowest, with 11.6 % for improved sanitation and 7.3 % for water connection in the home in 2014. Fifty-eight (58), 1.4 %, of children received all the eight (8) interventions in 2014, and none of those who received all these interventions died. After controlling for potential confounders, clean postnatal care was associated with a 66% reduction in the average odds of death (aOR = 0.34, 95 %CI:0.14-0.82), while early initiation of breastfeeding was associated with a 62 % reduction in the average odds of death (aOR = 0.38, 95 % CI: 0.21-0.69). CONCLUSIONS Two (clean postnatal care and early initiation of breastfeeding) out of eight interventions were associated with a reduction in the average odds of death. Thus, a further decline in under-five mortality in Ghana will require an increase in the coverage levels of these two high-impact interventions.
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Affiliation(s)
- Augusta Kolekang
- University for Development Studies, Accra Tamale, Ghana
- School of Public Health, University of Ghana, Legon Accra, Ghana
| | - Bismark Sarfo
- School of Public Health, University of Ghana, Legon Accra, Ghana
| | | | - Duah Dwomoh
- School of Public Health, University of Ghana, Legon Accra, Ghana
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15
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Owolabi O, Riley T, Otupiri E, Polis CB, Larsen-Reindorf R. The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study. BMC Health Serv Res 2021; 21:1104. [PMID: 34654428 PMCID: PMC8520210 DOI: 10.1186/s12913-021-07141-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/29/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. METHODS We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. RESULTS Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. DISCUSSION Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. CONCLUSIONS SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.
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Affiliation(s)
- Onikepe Owolabi
- Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY 10038 USA
- Vital Strategies, 100 Broadway, 4th Floor, New York, 10005 USA
| | - Taylor Riley
- Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY 10038 USA
| | - Easmon Otupiri
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Chelsea B. Polis
- Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY 10038 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Roderick Larsen-Reindorf
- Department of Obstetrics & Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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16
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Stierman EK, Ahmed S, Shiferaw S, Zimmerman LA, Creanga AA. Measuring facility readiness to provide childbirth care: a comparison of indices using data from a health facility survey in Ethiopia. BMJ Glob Health 2021; 6:e006698. [PMID: 34610906 PMCID: PMC8493923 DOI: 10.1136/bmjgh-2021-006698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/21/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Actionable information about the readiness of health facilities is needed to inform quality improvement efforts in maternity care, but there is no consensus on the best approach to measure readiness. Many countries use the WHO's Service Availability and Readiness Assessment (SARA) or the Demographic and Health Survey (DHS) Programme's Service Provision Assessment to measure facility readiness. This study compares measures of childbirth service readiness based on SARA and DHS guidance to an index based on WHO's quality of maternal and newborn care standards. METHODS We used cross-sectional data from Performance Monitoring for Action Ethiopia's 2019 survey of 406 health facilities providing childbirth services. We calculated childbirth service readiness scores using items based on SARA, DHS and WHO standards. For each, we used three aggregation methods for generating indices: simple addition, domain-weighted addition and principal components analysis. We compared central tendency, spread and item variation between the readiness indices; concordance between health facility scores and rankings; and correlations between readiness scores and delivery volume. RESULTS Indices showed moderate agreement with one another, and all had a small but significant positive correlation with monthly delivery volume. Ties were more frequent for indices with fewer items. More than two-thirds of items in the relatively shorter SARA and DHS indices were widely (>90%) available in hospitals, and half of the SARA items were widely (>90%) available in health centres/clinics. Items based on the WHO standards showed greater variation and captured unique aspects of readiness (eg, quality improvement processes, actionable information systems) not included in either the SARA or DHS indices. CONCLUSION SARA and DHS indices rely on a small set of widely available items to assess facility readiness to provide childbirth care. Expanded selection of items based on the WHO standards can better differentiate between levels of service readiness.
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Affiliation(s)
- Elizabeth K Stierman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saifuddin Ahmed
- Department of Population, Family And Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Linnea A Zimmerman
- Department of Population, Family And Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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17
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Baatiema L, Tanle A, Darteh EKM, Ameyaw EK. Is quality maternal healthcare all about successful childbirth? Views of mothers in the Wa Municipality, Ghana. PLoS One 2021; 16:e0257401. [PMID: 34525128 PMCID: PMC8443026 DOI: 10.1371/journal.pone.0257401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction In spite of the countless initiatives of the Ghana government to improve the quality of maternal healthcare, Upper West Region still records poor childbirth outcomes. This study, therefore, explored women’s perception of the quality of maternal healthcare they receive in the Wa Municipality of the Upper West Region of Ghana. Materials and methods This is a qualitative cross-sectional study of 62 women who accessed maternal healthcare in the Wa Municipality of Ghana. We analysed the transcripts using the analytic inductive technique. An inter-coding technique (testing for inter-coding agreement) was employed. The iterative coding process resulted in a coding scheme with four main themes. We used peer-debriefing technique in ensuring credibility and trustworthiness. Results Logistics and equipment; referral service; empathic service delivery; inadequacy of care providers; affordability of service; satisfaction with services received; as well as experience and service delivery were the parameters used by the women in assessing quality maternity care. A number of gaps were reported in the healthcare system including limited healthcare providers, limited beds and inefficient referral system. Conversely, some of them reported that some healthcare providers offered empathetic healthcare. Contrary views were expressed with respect to satisfaction with maternity care. Conclusion Government and all stakeholders seeking to enhance quality of maternal health and accelerate the attainment of the third Sustainable Development Goal need to reconsider the financing of service delivery at health institutions. Indeed, our findings have illustrated that routine workshops on empathetic healthcare are required in efforts to increase the rate of facility-based childbirth, and thereby subside maternal mortality and all adverse pregnancy outcomes.
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Affiliation(s)
- Linus Baatiema
- Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana
- * E-mail:
| | - Augustine Tanle
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Kofuor Maafo Darteh
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia
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Carter ED, Leslie HH, Marchant T, Amouzou A, Munos MK. Methodological considerations for linking household and healthcare provider data for estimating effective coverage: a systematic review. BMJ Open 2021; 11:e045704. [PMID: 34446481 PMCID: PMC8395298 DOI: 10.1136/bmjopen-2020-045704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess existing knowledge related to methodological considerations for linking population-based surveys and health facility data to generate effective coverage estimates. Effective coverage estimates the proportion of individuals in need of an intervention who receive it with sufficient quality to achieve health benefit. DESIGN Systematic review of available literature. DATA SOURCES Medline, Carolina Population Health Center and Demographic and Health Survey publications and handsearch of related or referenced works of all articles included in full text review. The search included publications from 1 January 2000 to 29 March 2021. ELIGIBILITY CRITERIA Publications explicitly evaluating (1) the suitability of data, (2) the implications of the design of existing data sources and (3) the impact of choice of method for combining datasets to obtain linked coverage estimates. RESULTS Of 3805 papers reviewed, 70 publications addressed relevant issues. Limited data suggest household surveys can be used to identify sources of care, but their validity in estimating intervention need was variable. Methods for collecting provider data and constructing quality indices were diverse and presented limitations. There was little empirical data supporting an association between structural, process and outcome quality. Few studies addressed the influence of the design of common data sources on linking analyses, including imprecise household geographical information system data, provider sampling design and estimate stability. The most consistent evidence suggested under certain conditions, combining data based on geographical proximity or administrative catchment (ecological linking) produced similar estimates to linking based on the specific provider utilised (exact match linking). CONCLUSIONS Linking household and healthcare provider data can leverage existing data sources to generate more informative estimates of intervention coverage and care. However, existing evidence on methods for linking data for effective coverage estimation are variable and numerous methodological questions remain. There is need for additional research to develop evidence-based, standardised best practices for these analyses.
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Affiliation(s)
- Emily D Carter
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hannah H Leslie
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Tanya Marchant
- Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Agbessi Amouzou
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dare S, Oduro AR, Owusu-Agyei S, Mackay DF, Gruer L, Manyeh AK, Nettey E, Phillips JF, Asante KP, Welaga P, Pell JP. Neonatal mortality rates, characteristics, and risk factors for neonatal deaths in Ghana: analyses of data from two health and demographic surveillance systems. Glob Health Action 2021; 14:1938871. [PMID: 34308793 PMCID: PMC8317945 DOI: 10.1080/16549716.2021.1938871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Reducing neonatal mortality rates (NMR) in developing countries is a key global health goal, but weak registration systems in the region stifle public health efforts. Objective To calculate NMRs, investigate modifiable risk factors, and explore neonatal deaths by place of birth and death, and cause of death in two administrative areas in Ghana. Methods Data on livebirths were extracted from the health and demographic surveillance systems in Navrongo (2004–2012) and Kintampo (2005–2010). Cause of death was determined from neonatal verbal autopsy forms. Univariable and multivariable logistic regression were used to analyse factors associated with neonatal death. Multiple imputations were used to address missing data. Results The overall NMR was 18.8 in Navrongo (17,016 live births, 320 deaths) and 12.5 in Kintampo (11,207 live births, 140 deaths). The annual NMR declined in both areas. 54.7% of the births occurred in health facilities. 70.9% of deaths occurred in the first week. The main causes of death were infection (NMR 4.3), asphyxia (NMR 3.7) and prematurity (NMR 2.2). The risk of death was higher among hospital births than home births: Navrongo (adjusted OR 1.14, 95% CI: 1.03–1.25, p = 0.01); Kintampo (adjusted OR 1.76, 95% CI: 1.55–2.00, p < 0.01). However, a majority of deaths occurred at home (Navrongo 61.3%; Kintampo 50.7%). Among hospital births dying in hospital, the leading cause of death was asphyxia; among hospital and home births dying at home, it was infection. Conclusion The NMR in these two areas of Ghana reduced over time. Preventing deaths by asphyxia and infection should be prioritised, centred respectively on improving post-delivery care in health facilities and subsequent post-natal care at home.
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Affiliation(s)
- Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Abraham R Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.,Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Laurence Gruer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alfred Kwesi Manyeh
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Ernest Nettey
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - James F Phillips
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Paul Welaga
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Jill P Pell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Delele TG, Biks GA, Abebe SM, Kebede ZT. Perceived quality of essential newborn care implementation among health facility deliveries in North Gondar Zone, Northwest Ethiopia: a cross-sectional study. Reprod Health 2021; 18:127. [PMID: 34120650 PMCID: PMC8201667 DOI: 10.1186/s12978-021-01175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality of essential newborn care is defined as the extent of health care services to improve the health of newborns. However, studies are scarce regarding the quality of newborn care implementation. Therefore, this study aimed to measure the magnitude and factors associated with essential newborn care implementation perceived quality among health facility deliveries in Northwest Ethiopia. METHODS A facility-based cross-sectional study design was employed to collect data from 370 randomly selected deliveries in 11 health facilities from November 2018 to March 2019. Essential newborn care implementation perceived quality was assessed in two domains (delivery and process) from clients' perspectives. A pre-tested interviewer-administered structured questionnaire was adopted from different kinds of literature and guidelines. The research data were collected by trained midwives and nurses. A binary logistic regression model was used to identify associated factors with newborn care implementation perceived quality. Odds ratio with 95% CI was computed to assess the strength and significant level of the association at p-value < 0.05. RESULTS About 338 mothers completed the interview with a response rate of 97.1%. The mean age of the study participants was 26.4 (SD = 5.7) with a range of 12 and 45 years. Most mothers, 84.3%, have attended antenatal care. The overall implementation perceived quality of essential newborn care was found to be 66.3%. The implementation perceived quality of cord care, breast-feeding and thermal care was 75.4, 72.2 and 66.3% respectively. Newborn immunization and vitamin K administration had the lowest implementation perceived quality i.e. 22.4 and 24.3% respectively. Friendly care during delivery (AOR = 5.1, 95% CI: 2.4, 11.0), partograph use (AOR = 3.0, 95% CI: 1.1, 8.6), child immunization service readiness (AOR = 2.9, 95% CI: 1.5, 5.7), BEmEONC service readiness (AOR = 2.1, 95% CI: 1.2, 3.9) and facing no neonatal illness at all (AOR = 4.2, 95% CI: 1.6, 10.9) were significantly associated with good essential newborn care implementation qualities. CONCLUSIONS The perceived quality of essential newborn care implementation was low in the study area. This is associated with poor readiness on BEmEONC and child immunization services, unfriendly care and not using partograph during delivery. Hence, availing the BEmEONC and the child immunization service inputs, continuous training and motivation of healthcare workers for friendly care are vital for improving essential newborn care implementation perceived quality.
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Affiliation(s)
- Tadesse Guadu Delele
- Department of Environmental and Occupational Health, and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Gashaw Andargie Biks
- Departments of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Departments of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Tigabu Kebede
- Departments of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Koulidiati JL, De Allegri M, Lohmann J, Hillebrecht M, Kiendrebeogo JA, Hamadou S, Hien H, Robyn PJ, Brenner S. Impact of Performance-Based Financing on effective coverage for curative child health services in Burkina Faso: Evidence from a quasi-experimental design. Trop Med Int Health 2021; 26:1002-1013. [PMID: 33910267 DOI: 10.1111/tmi.13596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of Performance-Based Financing (PBF) on effective coverage of child curative health services in primary healthcare facilities in Burkina Faso. METHODS An impact evaluation of a PBF pilot programme, using an experiment nested within a quasi-experimental design, was carried out in 12 intervention and 12 comparison districts in six regions of Burkina Faso. Across the 24 districts, primary healthcare facilities (537 both at baseline and endline) and households (baseline = 7978 endline = 7898) were surveyed. Within these households, 12 350 and 15 021 under-five-year-olds caretakers were interviewed at baseline and endline respectively. Linking service quality to service utilisation, we used difference-in-differences to estimate the impact of PBF on effective coverage of curative child health services. RESULTS Our study failed to detect any effect of PBF on effective coverage. Looking specifically into quality of care indicators, we detected a positive effect of PBF on structural elements of quality of care related to general service readiness, but not on the overall facility quality score, capturing both service readiness and the content of childcare. CONCLUSION The current study makes a unique contribution to PBF literature, as this is the first study assessing PBF impact on effective coverage for curative child health services in low-income settings. The absence of any significant effects of PBF on effective coverage suggests that PBF programmes require a stronger design focus on quality of care elements especially when implemented in a context of free healthcare policy.
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Affiliation(s)
- Jean-Louis Koulidiati
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg, Germany
| | - Julia Lohmann
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Hervé Hien
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | | | - Stephan Brenner
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg, Germany
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Aninanya GA, Otupiri E, Howard N. Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana. PLoS One 2021; 16:e0249778. [PMID: 33878127 PMCID: PMC8057590 DOI: 10.1371/journal.pone.0249778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Computerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana. METHODS We employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline. RESULTS The combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers' technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant. CONCLUSION This combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.
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Affiliation(s)
- Gifty Apiung Aninanya
- Department of Health Services Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Easmon Otupiri
- College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Natasha Howard
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom
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Rahman MA, Rahman MA, Rawal LB, Paudel M, Howlader MH, Khan B, Siddiquee T, Rahman A, Sarkar A, Rahman MS, Botlero R, Islam SMS. Factors influencing place of delivery: Evidence from three south-Asian countries. PLoS One 2021; 16:e0250012. [PMID: 33831127 PMCID: PMC8031333 DOI: 10.1371/journal.pone.0250012] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND High maternal mortality is still a significant public health challenge in many countries of the South-Asian region. The majority of maternal deaths occur due to pregnancy and delivery-related complications, which can mostly be prevented by safe facility delivery. Due to the paucity of existing evidence, our study aimed to examine the factors associated with place of delivery, including women's preferences for such in three selected South-Asian countries. METHODS We extracted data from the most recent demographic and health surveys (DHS) conducted in Bangladesh (2014), Nepal (2016), and Pakistan (2017-18) and analyzed to identify the association between the outcome variable and socio-demographic characteristics. A total of 16,429 women from Bangladesh (4278; mean age 24.57 years), Nepal (3962; mean age 26.35 years), and Pakistan (8189; mean age 29.57 years) were included in this study. Following descriptive analyses, bivariate and multivariate logistic regressions were conducted. RESULTS Overall, the prevalence of facility-based delivery was 40%, 62%, and 69% in Bangladesh, Nepal, and Pakistan, respectively. Inequity in utilizing facility-based delivery was observed for women in the highest wealth quintile. Participants from Urban areas, educated, middle and upper household economic status, and with high antenatal care (ANC) visits were significantly associated with facility-based delivery in all three countries. Interestingly, watching TV was also found as a strong determinant for facility-based delivery in Bangladesh (aOR = 1.31, 95% CI:1.09-1.56, P = 0.003), Nepal (aOR = 1.42, 95% CI:1.20-1.67, P<0.001) and Pakistan (aOR = 1.17, 95% CI: 1.03-1.32, P = 0.013). Higher education of husband was a significant predictor for facility delivery in Bangladesh (aOR = 1.73, 95% CI:1.27-2.35, P = 0.001) and Pakistan (aOR = 1.19, 95% CI: 0.99-1.43, P = 0.065); husband's occupation was also a significant factor in Bangladesh (aOR = 1.30, 95% CI:1.04-1.61, P = 0.020) and Nepal (aOR = 1.26, 95% CI:1.01-1.58, P = 0.041). CONCLUSION Our findings suggest that the educational status of both women and their husbands, household economic situation, and the number of ANC visits influenced the place of delivery. There is an urgent need to promote facility delivery by building more birthing facilities, training and deployment of skilled birth attendants in rural and hard-to-reach areas, ensuring compulsory female education for all women, encouraging more ANC visits, and providing financial incentives for facility deliveries. There is a need to promote facility delivery by encouraging health facility visits through utilizing social networks and continuing mass media campaigns. Ensuring adequate Government funding for free maternal and newborn health care and local community involvement is crucial for reducing maternal and neonatal mortality and achieving sustainable development goals in this region.
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Affiliation(s)
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, VIC, Australia
- Australian Institute of Primary Care & Ageing (AIPCA), La Trobe University, Melbourne, VIC, Australia
- Department of Non-Communicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Lal B. Rawal
- School of Health Medical and Applied Sciences, College of Sciences and Sustainability, Central Queensland University, Sydney Campus, Sydney, Australia
| | | | | | - Bayezid Khan
- Development Studies Discipline, Khulna University, Khulna, Bangladesh
| | | | - Abdur Rahman
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | | | - Roslin Botlero
- Monash Global and Women’s Health Unit, Monash University, Melbourne, VIC, Australia
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Understanding the barriers to Ghanaian midwives’ ability to provide quality care: Using classic Grounded theory methodology in a new context. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Young MR, Morof D, Lathrop E, Haddad L, Blanton C, Maro G, Serbanescu F. Beyond adequate: Factors associated with quality of antenatal care in western Tanzania. Int J Gynaecol Obstet 2020; 151:431-437. [PMID: 32799345 DOI: 10.1002/ijgo.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/28/2020] [Accepted: 08/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine quality of antenatal care (ANC). Most literature focuses on ANC attendance and services. Less is known about quality of care (QoC). METHOD Data were analyzed from the 2016 Kigoma Reproductive Health Survey, a population-based survey of reproductive-aged women. Women with singleton term live births were included and principal component analysis (PCA) was used to create an ANC quality index using linear combinations of weights of the first principal component. Nineteen variables were selected for the index. The index was then used to assign a QoC score for each woman and linear regression used to identify factors associated with receiving higher QoC. RESULTS A total of 3178 women received some ANC. Variables that explained the most variance in the QoC index included: gave urine (0.35); gave blood (0.34); and blood pressure measured (0.30). In multivariable linear regression, factors associated with higher QoC included: ANC at a hospital (versus dispensary); older age; higher level of education; working outside the home; higher socioeconomic status; and having lower parity. CONCLUSION Using PCA methods, several basic components of ANC including maternal physical assessment were identified as important indicators of quality. This approach provides an affordable and effective means of evaluating ANC programs.
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Affiliation(s)
- Marisa R Young
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Diane Morof
- Division of Global HIV/AIDS and Tuberculosis, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Lisa Haddad
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Curtis Blanton
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Godson Maro
- Bloomberg Philanthropies, Dar es Salaam, Tanzania
| | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Pindani M, Phiri C, Chikazinga W, Chilinda I, Botha J, Chorwe-Sungani G. Assessing the quality of postnatal care offered to mothers and babies by midwives in Lilongwe District. S Afr Fam Pract (2004) 2020; 62:e1-e6. [PMID: 32787385 PMCID: PMC8378184 DOI: 10.4102/safp.v62i1.5026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/14/2020] [Accepted: 04/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background The quality of care received by mothers and newborns in low-resource settings is often poor. This may partly explain the high rates of maternal deaths (60%) that occur during the postpartum period in Malawi. However, the quality of care provided to mothers and newborns in the country has not been adequately assessed. Therefore, this study aimed at assessing the quality of postnatal care services offered to mothers and babies by midwives in Lilongwe District. Methods This was a quantitative study that used a sample of 58 midwives to assess the quality of postnatal care at three selected health facilities. A structured questionnaire, an observation tool and a facility checklist were used to collect data. Descriptive statistics were used to analyse the data. The study received ethics approval from the relevant authority. Results The study found that the percentages reported by midwives regarding client monitoring varied and were below the 80% threshold. Midwives did not always follow the reproductive health standards on client examination so that less than 75% of midwives inspected perineal wounds (52.2%), checked vital signs of neonate (66.7%) and mother (62.2%), and inspected lochia drainage (30.4%). Most midwives (91.3%) never assessed the emotional state of the mother. Midwives covered a range of topics during health education and counselling. However, some topics, including immunisations (31.1%), were never taught. Conclusion The study has suggested that the postnatal care offered by midwives at three health facilities was generally substandard and midwives do not always monitor, assess and counsel postnatal clients.
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Affiliation(s)
- Mercy Pindani
- Department of Community Health, Faculty of Community Health Studies, Kamuzu College of Nursing, Lilongwe.
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“Doing Magic With Very Little”: Barriers to Ghanaian Midwives' Ability to Provide Quality Maternal and Neonatal Care. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSEThis study identified barriers that affected Ghanaian midwives' ability to provide quality care to prevent maternal and neonatal mortality.DESIGNGlaserian Grounded Theory was the framework of this study. Interviews were conducted with 33 participants from 10 facilities in seven districts in one region in southern Ghana.FINDINGSMidwives are committed to do their best to provide quality care to women and newborns. Barriers to their care included a lack of resources of care, unsupportive facility management, and client related barriers.CONCLUSIONSMeasures to reduce barriers for midwives to provide quality care must improve health financing at a national and facility level; the encouragement of supportive supervision and management at a facility level; and actions to enhance midwife engagement with clients and communities.
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Weldearegay HG, Kahsay AB, Medhanyie AA, Godefay H, Petrucka P. Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study. PLoS One 2020; 15:e0234318. [PMID: 32530944 PMCID: PMC7292403 DOI: 10.1371/journal.pone.0234318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. Methods A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. Results This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (β = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (β = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (β = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (β = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (β = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (β = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (β = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers’ satisfaction (β = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers’ skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. Conclusions There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers’ level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers’ work-related burnout.
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Affiliation(s)
| | | | | | | | - Pammla Petrucka
- University of Saskatchewan, College of Nursing, Canada and Adjunct Nelson Mandela African Institute of Science and Technology, Tanzania, Canada
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Larson E, Mbaruku GM, Cohen J, Kruk ME. Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study. Int J Qual Health Care 2020; 32:54-63. [PMID: 31829427 PMCID: PMC7172021 DOI: 10.1093/intqhc/mzz126] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 10/14/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To test the success of a maternal healthcare quality improvement intervention in actually improving quality. DESIGN Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls. SETTING Four districts in rural Tanzania. PARTICIPANTS Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseline; 886 at endline). INTERVENTIONS In-service training, mentorship and supportive supervision and infrastructure support. MAIN OUTCOME MEASURES We measured fidelity with indictors of quality and compared quality between intervention and control facilities using difference-in-differences analysis. RESULTS Quality of care was low at baseline: the average provider knowledge test score was 46.1% (range: 0-75%) and only 47.9% of women were very satisfied with delivery care. The intervention was associated with an increase in newborn counseling (β: 0.74, 95% CI: 0.13, 1.35) but no evidence of change across 17 additional indicators of quality. On average, facilities reached 39% implementation. Comparing facilities with the highest implementation of the intervention to control facilities again showed improvement on only one of the 18 quality indicators. CONCLUSIONS A multi-faceted quality improvement intervention resulted in no meaningful improvement in quality. Evidence suggests this is due to both failure to sustain a high-level of implementation and failure in theory: quality improvement interventions targeted at the clinic-level in primary care clinics with weak starting quality, including poor infrastructure and low provider competence, may not be effective.
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Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Jessica Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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McCarthy KJ, Blanc AK, Warren C, Bajracharya A, Bellows B. Validating women’s reports of antenatal and postnatal care received in Bangladesh, Cambodia and Kenya. BMJ Glob Health 2020. [PMCID: PMC7245420 DOI: 10.1136/bmjgh-2019-002133] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundGlobal indicators for monitoring progress in maternal and newborn health have tended to rely on contact coverage indicators rather than the content of services received. As part of the effort to improve measurement of progress in maternal and newborn health, this study examines how accurately women can report on information and health interventions received during an antenatal or postnatal health consultation at health facilities in Bangladesh, Cambodia and Kenya.MethodsWe conducted secondary analysis of matched observation and client interview data to compare women’s reports of care received at exit interview with observation by a trained third-party observer. We assessed indicator accuracy by calculating sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and inflation factor (IF). Indicators considered to have both high individual accuracy (an AUC value of 0.70 or greater) and low population-level bias (0.75<IF<1.25) were considered to have acceptable validity. In addition, we considered the number of countries where both validation criteria were met.ResultsFor indicators of antenatal care, we found 16 of 18 indicators in Bangladesh, 3 of 6 in Cambodia and 3 of 8 in Kenya met both validation criteria. For postnatal care, we found evidence of acceptable validity for 6 of 8 indicators in Bangladesh, 5 of 14 in Cambodia and 3 of 16 in Kenya. In general, we documented higher validity for indicators related to concrete, observable actions, as opposed to information or advice given. Women were more likely to recall care received for themselves, rather than for their newborn.ConclusionsWomen reported accurately on multiple aspects of antenatal and postnatal care. While we describe broad patterns in the types of indicators likely to be recalled with accuracy, differences by setting warrant further investigation. Findings inform efforts to better monitor the coverage and quality of maternal and newborn health interventions.
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Affiliation(s)
- Katharine J McCarthy
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
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Montagu D, Landrian A, Kumar V, Phillips BS, Singhal S, Mishra S, Singh S, Cotter SY, Singh VP, Kajal F, Sudhinaraset M. Patient-experience during delivery in public health facilities in Uttar Pradesh, India. Health Policy Plan 2020; 34:574-581. [PMID: 31419287 PMCID: PMC6794568 DOI: 10.1093/heapol/czz067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 11/12/2022] Open
Abstract
In India, most women now delivery in hospitals or other facilities, however, maternal and neonatal mortality remains stubbornly high. Studies have shown that mistreatment causes delays in care-seeking, early discharge and poor adherence to post-delivery guidance. This study seeks to understand the variation of women’s experiences in different levels of government facilities. This information can help to guide improvement planning. We surveyed 2018 women who gave birth in a representative set of 40 government facilities from across Uttar Pradesh (UP) state in northern India. Women were asked about their experiences of care, using an established scale for person-centred care. We asked questions specific to treatment and clinical care, including whether tests such as blood pressure, contraction timing, newborn heartbeat or vaginal exams were conducted, and whether medical assessments for mothers or newborns were done prior to discharge. Women delivering in hospitals reported less attentive care than women in lower-level facilities, and were less trusting of their providers. After controlling for a range of demographic attributes, we found that better access, higher clinical quality, and lower facility-level, were all significantly predictive of patient-centred care. In UP, lower-level facilities are more accessible, women have greater trust for the providers and women report being better treated than in hospitals. For the vast majority of women who will have a safe and uncomplicated delivery, our findings suggest that the best option would be to invest in improvements mid-level facilities, with access to effective and efficient emergency referral and transportation systems should they be needed.
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Affiliation(s)
- Dominic Montagu
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, Mission Hall 550 16th St. 3rd Floor, San Francisco, CA, USA
| | - Amanda Landrian
- Jonathan and Karin Fielding School of Public Health, University of California, 650 Charles E. Young Dr. South, Los Angeles, CA, USA
| | | | - Beth S Phillips
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, Mission Hall 550 16th St. 3rd Floor, San Francisco, CA, USA
| | - Shreya Singhal
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | | | | | - Sun Yu Cotter
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, Mission Hall 550 16th St. 3rd Floor, San Francisco, CA, USA
| | | | - Fnu Kajal
- National Health Mission, Lucknow, Uttar Pradesh, India
| | - May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, 650 Charles E. Young Dr. South, Los Angeles, CA, USA
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Tiruneh GT, Zemichael NF, Betemariam WA, Karim AM. Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation. PLoS One 2020; 15:e0228137. [PMID: 32023275 PMCID: PMC7001957 DOI: 10.1371/journal.pone.0228137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/08/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction We implemented a participatory quality improvement strategy in eight primary health care units of Ethiopia to improve use and quality of maternal and newborn health services. Methods We evaluated the effects of this strategy using mixed-methods research. We used before-and-after (March 2016 and November 2017) cross-sectional surveys of women who had children 0–11 months to compare changes in maternal and newborn health care indicators in the 39 communities that received the intervention and the 148 communities that did not. We used propensity scores to match the intervention with the comparison communities at baseline and difference-in-difference analyses to estimate intervention effects. The qualitative method included 51 in-depth interviews of community volunteers, health extension workers, health center directors and staff, and project specialists. Results The difference-in-difference analyses indicated that 7.9 percentage points (95% confidence interval [CI]: 1.8–13.9%) increase in receiving skilled delivery care between baseline and follow-up surveys in the intervention area that is attributable to the strategy. The intervention effect on postnatal care in 48 hours of the mother was 15.3% (95% CI: 7.4–23.2). However, there was no evidence that the strategy affected the seven other maternal and newborn health care indicators considered. Interview participants said that the participatory design and implementation strategy helped them to realize gaps, identify real problems, and design appropriate solutions, and created a sense of ownership and shared responsibility for implementing interventions. Conclusions Community participation in planning and monitoring maternal and newborn health service delivery improves use of some high-impact maternal and newborn health services. The study supports the notion that participatory community strategies should be considered to foster community-responsive health systems.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) 2020 Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
- * E-mail: (GTT); (AMK)
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers (L10K) 2020 Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Wuleta Aklilu Betemariam
- The Last Ten Kilometers (L10K) 2020 Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Ali Mehryar Karim
- Bill & Melinda Gates Foundation, Addis Ababa, Ethiopia
- * E-mail: (GTT); (AMK)
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Horwood C, Haskins L, Luthuli S, McKerrow N. Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa. BMC Pediatr 2019; 19:496. [PMID: 31842824 PMCID: PMC6913017 DOI: 10.1186/s12887-019-1874-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is a high global burden of neonatal mortality, with many newborn babies dying of preventable and treatable conditions, particularly in low and middle-income countries. Improving quality of newborn care could save the lives of many thousands of babies. Quality of care (QoC) is a complex and multifaceted construct that is difficult to measure, but patients’ experiences of care are an important component in any measurement of QoC. We report the findings of a qualitative study exploring observations and experiences of health workers (HWs) and mothers of babies in neonatal units in South Africa. Methods A qualitative case study approach was adopted to explore care of newborn babies admitted to neonatal units in district hospitals. Observation data were collected by a registered nurse during working hours over a continuous five-day period. Doctors and nurses working in the neonatal unit and mothers of babies admitted during the observation period were interviewed using a semi-structured interview guide. All interviews were audio recorded. Observation data were transcribed from hand written notes. Audiotapes of interviews were transcribed verbatim and, where necessary, translated into English. A thematic content analysis was used to analyse the data. Results Observations and interviews were conducted in seven participating hospitals between November 2015 and May 2016. Our findings highlight the importance of information sharing between HWs and mothers of babies, contrasting the positive communication reported by many mothers which led to them feeling empowered and participating actively in the care of their babies, with incidents of poor communication. Poor communication, rudeness and disrespectful behaviour of HWs was frequently described by mothers, and led to mothers feeling anxious, unwilling to ask questions and excluded from their baby’s care. In some cases poor communication and misunderstandings led to serious mismanagement of babies with HWs delaying or withholding care, or to mothers putting their babies at risk by not following instructions. Conclusion Good communication between mothers and HWs is critical for building mothers’ confidence, promoting bonding and participation of mothers in the care of their baby and may have long term benefits for the health and well-being of the mother and her baby.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa.
| | - Silondile Luthuli
- Centre for Rural Health, University of KwaZulu-Natal, George Campbell Building, Howard College Campus, Durban, South Africa
| | - Neil McKerrow
- KwaZulu-Natal Department of Health, Durban, South Africa.,Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Dennis ML, Owolabi OO, Cresswell JA, Chelwa N, Colombini M, Vwalika B, Mbizvo MT, Campbell OMR. A new approach to assess the capability of health facilities to provide clinical care for sexual violence against women: a pilot study. Health Policy Plan 2019; 34:92-101. [PMID: 30753452 DOI: 10.1093/heapol/czy106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 11/15/2022] Open
Abstract
Several tools have been developed to collect information on health facility preparedness to provide sexual violence response services; however, little guidance exists on how this information can be used to better understand which functions a facility can perform. Our study therefore aims to propose a set of signal functions that provide a framework for monitoring the availability of clinical sexual violence services. To illustrate the potential insights that can be gained from using our proposed signal functions, we used the framework to analyse data from a health facility census conducted in Central Province, Zambia. We collected the geographic coordinates of health facilities and police stations to assess women's proximity to multi-sectoral sexual violence response services. We defined three key domains of clinical sexual violence response services, based on the timing of the visit to the health facility in relation to the most recent sexual assault: (1) core services, (2) immediate care, and (3) delayed and follow-up care. Combining information from all three domains, we estimate that just 3% of facilities were able to provide a comprehensive response to sexual violence, and only 16% could provide time-sensitive immediate care services such as HIV post-exposure prophylaxis and emergency contraception. Services were concentrated in hospitals, with few health centres and no health posts fulfilling the signal functions for any of the three domains. Only 23% of women lived within 15 km of comprehensive clinical sexual violence health services, and 38% lived within 15 km of immediate care. These findings point to a need to develop clear strategies for decentralizing sexual violence services to maximize coverage and ensure equity in access. Overall, our findings suggest that our proposed signal functions could be a simple and valuable approach for assessing the availability of clinical sexual violence response services, identifying areas for improvement and tracking improvements over time.
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Affiliation(s)
- Mardieh L Dennis
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Onikepe O Owolabi
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, USA
| | - Jenny A Cresswell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Nachela Chelwa
- Population Council, Zambia office, No. 4 Mwaleshi Road, Lusaka, Zambia
| | - Manuela Colombini
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, UK
| | - Bellington Vwalika
- School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Michael T Mbizvo
- Population Council, Zambia office, No. 4 Mwaleshi Road, Lusaka, Zambia
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Phillips BS, Singhal S, Mishra S, Kajal F, Cotter SY, Sudhinaraset M. Evaluating concordance between government administrative data and externally collected data among high-volume government health facilities in Uttar Pradesh, India. Glob Health Action 2019; 12:1619155. [PMID: 31159680 PMCID: PMC6566647 DOI: 10.1080/16549716.2019.1619155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Globally, opportunities to validate government reports through external audits are rare, notably in India. A cross-sectional maternal health study in Uttar Pradesh, India's most populous state, compares government administrative data and externally collected data on maternal health service indicators. Objectives: Our study aims to determine the level of concordance between government-reported health facility data compared to externally collected health facility data on the same maternal healthcare quality indicators. Second, our study aims to explore whether the level of agreement between government administrative data versus the externally collected data differs by level of facility or by type of maternal health service. Methods: Facility assessment surveys were administered to key health staff by government-hired enumerators from January 2017 to March 2017 at nearly 750 government health facilities across UP. The same survey was re-conducted by external data collectors from August 2017 to October 2017 at 40 of the same facilities. We conduct comparative analyses of the two datasets for agreement among the same measures of maternal healthcare quality. Results: The findings indicate concordance between most indicators across government administrative data and externally collected health facility data. However, when stratified by facility-level or service type, results suggest significant over-reporting in the government administrative data on indicators that are incentivized. This finding is consistent across all levels of facilities; however, the most significant disparities appear at higher-level facilities, namely District Hospitals. Conclusion: This study has a number of important programmatic and policy implications. Government administrative health data have the potential to be highly critical in informing large-scale quality improvements in maternal healthcare quality, but its credibility must be readily verifiable and accessible to politicians, researchers, funders, and most importantly, the public, to improve the overall health, patient experience, and well-being of women and newborns.
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Affiliation(s)
- Beth S Phillips
- a Institute of Global Health Sciences, University of California , San Francisco , CA , USA
| | | | - Shambhavi Mishra
- c Department of Statistics , University of Lucknow , Lucknow , India
| | - Fnu Kajal
- d National Health Mission , Lucknow , India
| | - Sun Yu Cotter
- a Institute of Global Health Sciences, University of California , San Francisco , CA , USA
| | - May Sudhinaraset
- a Institute of Global Health Sciences, University of California , San Francisco , CA , USA.,e Jonathan and Karin Fielding School of Public Health , University of California , Los Angeles , CA , USA
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Kushitor MK, Biney AA, Wright K, Phillips JF, Awoonor-Williams JK, Bawah AA. A qualitative appraisal of stakeholders' perspectives of a community-based primary health care program in rural Ghana. BMC Health Serv Res 2019; 19:675. [PMID: 31533696 PMCID: PMC6751899 DOI: 10.1186/s12913-019-4506-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/03/2019] [Indexed: 12/05/2022] Open
Abstract
Background The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana’s flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community’s perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study. Method Applying a qualitative research methodology, this study analysed transcripts from 20 focus group discussions (FGDs) in four functional CHPS zones in separate districts of the Northern and Volta Regions of Ghana to understand the community’s assessment of CHPS. The study employed the thematic analysis to explore the content of the CHPS service provision, delivery and how community members feel about the service. In addition, ordinary least regression model was applied in interpreting 126 scores consigned to CHPS by the study respondents. Results Two broad areas of consensus were observed: general favourable and general unfavourable thematic areas. Favourable themes were informed by approval, appreciation, hard work and recognition of excellent services. The unfavourable thematic area was informed by rudeness, extortion, inappropriate and unprofessional behaviour, lack of basic equipment and disappointments. The findings show that mothers of children under the age of five, adolescent girls without children, and community leaders generally expressed favourable perceptions of CHPS while fathers of children under the age of five and adolescent boys without children had unfavourable expressions about the CHPS program. A narrow focus on maternal and child health explains the demographic divide on the perception of CHPS. The study revealed wide disparities in actual CHPS deliverables and community expectations. Conclusions A communication gap between health care providers and community members explains the high and unrealistic expectations of CHPS. Efforts to improve program acceptability and impact should address the need for more general outreach to social networks and men rather than a sole focus on facility-based maternal and child health care.
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Affiliation(s)
- Mawuli K Kushitor
- Regional Institute for Population Studies (RIPS), University of Ghana, P.O.Box LG 96, Legon, Ghana.
| | - Adriana A Biney
- Regional Institute for Population Studies (RIPS), University of Ghana, P.O.Box LG 96, Legon, Ghana
| | - Kalifa Wright
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Ayaga A Bawah
- Regional Institute for Population Studies (RIPS), University of Ghana, P.O.Box LG 96, Legon, Ghana
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Okawa S, Gyapong M, Leslie H, Shibanuma A, Kikuchi K, Yeji F, Tawiah C, Addei S, Nanishi K, Oduro AR, Owusu-Agyei S, Ansah E, Asare GQ, Yasuoka J, Hodgson A, Jimba M. Effect of continuum-of-care intervention package on improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled trial. BMJ Open 2019; 9:e025347. [PMID: 31511278 PMCID: PMC6738678 DOI: 10.1136/bmjopen-2018-025347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a continuum-of-care intervention package on adequate contacts of women and newborn with healthcare providers and their reception of high-quality care. DESIGN Cluster randomised controlled trial. SETTING 32 subdistricts in 3 rural sites in Ghana. PARTICIPANTS The baseline survey involved 1480 women who delivered before the trial, and the follow-up survey involved 1490 women who received maternal and newborn care during the trial. INTERVENTIONS The intervention package included training healthcare providers, using an educational and recording tool named 'continuum-of-care card', providing the first postnatal care (PNC) by retaining women and newborns at healthcare facility or home visit by healthcare providers. OUTCOME MEASURES Adequate contacts were defined as at least four contacts during pregnancy, delivery with assistance of skilled healthcare providers at a healthcare facility and three timely contacts within 6 weeks postpartum. High-quality care was defined as receiving 6 care items for antenatal care (ANC), 3 for peripartum care (PPC) and 14 for PNC. RESULTS The difference-in-difference method was used to assess the effects of the intervention on the study outcome. The percentage of adequate contacts with high-quality care in the intervention group in the follow-up survey and the adjusted difference-in-difference estimators were 12.6% and 2.2 (p=0.61) at ANC, 31.5% and 1.9 (p=0.73) at PPC and 33.7% and 12.3 (p=0.13) at PNC in the intention-to-treat design, whereas 13.0% and 2.8 (p=0.54) at ANC, 34.2% and 2.7 (p=0.66) at PPC and 38.1% and 18.1 (p=0.02) at PNC in the per-protocol design that assigned the study sample by possession of the continuum-of-care card. CONCLUSIONS The interventions improved contacts with healthcare providers and quality of care during PNC. However, having adequate contact did not guarantee high-quality care. Maternal and newborn care in Ghana needs to improve its continuity and quality. TRIAL REGISTRATION NUMBER ISRCTN90618993. .
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Affiliation(s)
- Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Margaret Gyapong
- Dodowa Health Research Centre, Dodowa, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Hannah Leslie
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Francis Yeji
- Navrongo Health Research Centre, Navrongo, Ghana
| | | | | | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | - Evelyn Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | | | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Gabrysch S, Nesbitt RC, Schoeps A, Hurt L, Soremekun S, Edmond K, Manu A, Lohela TJ, Danso S, Tomlin K, Kirkwood B, Campbell OMR. Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trials. Lancet Glob Health 2019; 7:e1074-e1087. [PMID: 31303295 PMCID: PMC6639244 DOI: 10.1016/s2214-109x(19)30165-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/12/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal and perinatal mortality are still unacceptably high in many countries despite steep increases in facility birth. The evidence that childbirth in facilities reduces mortality is weak, mainly because of the scarcity of robust study designs and data. We aimed to assess this link by quantifying the influence of major determinants of facility birth (cluster-level facility birth, wealth, education, and distance to childbirth care) on several mortality outcomes, while also considering quality of care. METHODS Our study is a secondary analysis of surveillance data on 119 244 pregnancies from two large population-based cluster-randomised controlled trials in Brong Ahafo, Ghana. In addition, we specifically collected data to assess quality of care at all 64 childbirth facilities in the study area. Outcomes were direct maternal mortality, perinatal mortality, first-day and early neonatal mortality, and antepartum and intrapartum stillbirth. We calculated cluster-level facility birth as the percentage of facility births in a woman's village over the preceding 2 years, and we computed distances from women's regular residence to health facilities in a geospatial database. Associations between determinants of facility birth and mortality outcomes were assessed in crude and multivariable multilevel logistic regression models. We stratified perinatal mortality effects by three policy periods, using April 1, 2005, and July 1, 2008, as cutoff points, when delivery-fee exemption and free health insurance were introduced in Ghana. These policies increased facility birth and potentially reduced quality of care. FINDINGS Higher proportions of facility births in a cluster were not linked to reductions in any of the mortality outcomes. In women who were wealthier, facility births were much more common than in those who were poorer, but mortality was not lower among them or their babies. Women with higher education had lower mortality risks than less-educated women, except first-day and early neonatal mortality. A substantially higher proportion of women living in areas closer to childbirth facilities had facility births and caesarean sections than women living further from childbirth facilities, but mortality risks were not lower despite this increased service use. Among women who lived in areas closer to facilities offering comprehensive emergency obstetric care (CEmOC), emergency newborn care, or high-quality routine care, or to facilities that had providers with satisfactory competence, we found a lower risk of intrapartum stillbirth (14·2 per 1000 deliveries at >20 km from a CEmOC facility vs 10·4 per 1000 deliveries at ≤1 km; odds ratio [OR] 1·13, 95% CI 1·06-1·21) and of composite mortality outcomes than among women living in areas where these services were further away. Protective effects of facility birth were restricted to the two earlier policy periods (from June 1, 2003, to June 30, 2008), whereas there was evidence for higher perinatal mortality with increasing wealth (OR 1·09, 1·03-1·14) and lower perinatal mortality with increasing distance from childbirth facilities (OR 0·93, 0·89-0·98) after free health insurance was introduced in July 1, 2008. INTERPRETATION Facility birth does not necessarily convey a survival benefit for women or babies and should only be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safe-guarding uncomplicated births. FUNDING The Baden-Württemberg Foundation, the Daimler and Benz Foundation, the European Social Fund and Ministry of Science, Research, and the Arts Baden-Württemberg, WHO, US Agency for International Development, Save the Children, the Bill & Melinda Gates Foundation, and the UK Department for International Development.
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Affiliation(s)
- Sabine Gabrysch
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Robin C Nesbitt
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Anja Schoeps
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Lisa Hurt
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Seyi Soremekun
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Observational and Pragmatic Research Institute, Singapore
| | - Karen Edmond
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alexander Manu
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Kintampo Health Research Centre, Kintampo, Ghana; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Terhi J Lohela
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Samuel Danso
- Kintampo Health Research Centre, Kintampo, Ghana; University of Edinburgh Medical School, Edinburgh, UK
| | - Keith Tomlin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Betty Kirkwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Amouzou A, Leslie HH, Ram M, Fox M, Jiwani SS, Requejo J, Marchant T, Munos MK, Vaz LME, Weiss W, Hayashi C, Boerma T. Advances in the measurement of coverage for RMNCH and nutrition: from contact to effective coverage. BMJ Glob Health 2019; 4:e001297. [PMID: 31297252 PMCID: PMC6590972 DOI: 10.1136/bmjgh-2018-001297] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/28/2019] [Accepted: 04/06/2019] [Indexed: 11/17/2022] Open
Abstract
Current methods for measuring intervention coverage for reproductive, maternal, newborn, and child health and nutrition (RMNCH+N) do not adequately capture the quality of services delivered. Without information on the quality of care, it is difficult to assess whether services provided will result in expected health improvements. We propose a six-step coverage framework, starting from a target population to (1) service contact, (2) likelihood of services, (3) crude coverage, (4) quality-adjusted coverage, (5) user-adherence-adjusted coverage and (6) outcome-adjusted coverage. We support our framework with a comprehensive review of published literature on effective coverage for RMNCH+N interventions since 2000. We screened 8103 articles and selected 36 from which we summarised current methods for measuring effective coverage and computed the gaps between ‘crude’ coverage measures and quality-adjusted measures. Our review showed considerable variability in data sources, indicator definitions and analytical approaches for effective coverage measurement. Large gaps between crude coverage and quality-adjusted coverage levels were evident, ranging from an average of 10 to 38 percentage points across the RMNCH+N interventions assessed. We define effective coverage as the proportion of individuals experiencing health gains from a service among those who need the service, and distinguish this from other indicators along a coverage cascade that make quality adjustments. We propose a systematic approach for analysis along six steps in the cascade. Research to date shows substantial drops in effective delivery of care across these steps, but variation in methods limits comparability of the results. Advancement in coverage measurement will require standardisation of effective coverage terminology and improvements in data collection and methodological approaches.
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Affiliation(s)
- Agbessi Amouzou
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hannah Hogan Leslie
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Malathi Ram
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Monica Fox
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Safia S Jiwani
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Requejo
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Data and Analytics Section, Division of Data, Research and Policy, UNICEF USA, New York, New York, USA
| | - Tanya Marchant
- Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Melinda Kay Munos
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lara M E Vaz
- Global Health, Save the Children, Fairfield, Connecticut, USA
| | - William Weiss
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chika Hayashi
- Data and Analytics Section, Division of Data, Research and Policy, UNICEF USA, New York, New York, USA
| | - Ties Boerma
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Wang W, Mallick L, Allen C, Pullum T. Effective coverage of facility delivery in Bangladesh, Haiti, Malawi, Nepal, Senegal, and Tanzania. PLoS One 2019; 14:e0217853. [PMID: 31185020 PMCID: PMC6559642 DOI: 10.1371/journal.pone.0217853] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/19/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The persistence of preventable maternal and newborn deaths highlights the importance of quality of care as an essential element in coverage interventions. Moving beyond the conventional measurement of crude coverage, we estimated effective coverage of facility delivery by adjusting for facility preparedness to provide delivery services in Bangladesh, Haiti, Malawi, Nepal, Senegal, and Tanzania. METHODS The study uses data from Demographic and Health Surveys (DHS) and Service Provision Assessments (SPA) in Bangladesh (2014 DHS and 2014 SPA), Haiti (2012 DHS and 2013 SPA), Malawi (2015-16 DHS and 2013-14 SPA), Nepal (2016 DHS and 2015 SPA), Senegal (2016 DHS and 2015 SPA), and Tanzania (2015-16 DHS and 2014-15 SPA). We defined effective coverage as the mathematical product of crude coverage and quality of care. The coverage of facility delivery was measured with DHS data and quality of care was measured with facility data from SPA. We estimated effective coverage at both the regional and the national level and accounted for type of facility where delivery care was sought. FINDINGS The findings from the six countries indicate the effective coverage ranges from 24% in Haiti to 66% in Malawi, representing substantial reductions (20% to 39%) from crude coverage rates. Although Malawi has achieved almost universal coverage of facility delivery (93%), effective coverage was only 66%.vSuch gaps between the crude coverage and the effective coverage suggest that women delivered in health facility but did not necessarily receive an adequate quality of care. In all countries except Malawi, effective coverage differed substantially among the country's regions of the country, primarily due to regional variability in coverage. INTERPRETATION Our findings reinforce the importance of quality of obstetric and newborn care to achieve further reduction of maternal and newborn mortality. Continued efforts are needed to increase the use of facility delivery service in countries or regions where coverage remains low.
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Affiliation(s)
- Wenjuan Wang
- The Demographic and Health Surveys (DHS) Program, Division of International Health and Development, ICF, Rockville, Maryland, United States of America
| | - Lindsay Mallick
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - Courtney Allen
- The Demographic and Health Surveys (DHS) Program, Division of International Health and Development, ICF, Rockville, Maryland, United States of America
| | - Thomas Pullum
- The Demographic and Health Surveys (DHS) Program, Division of International Health and Development, ICF, Rockville, Maryland, United States of America
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Chukwuma A, Mbachu C, McConnell M, Bossert TJ, Cohen J. The impact of monetary incentives on referrals by traditional birth attendants for postnatal care in Nigeria. BMC Pregnancy Childbirth 2019; 19:150. [PMID: 31104629 PMCID: PMC6526614 DOI: 10.1186/s12884-019-2313-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gaps in postnatal care use represent missed opportunities to prevent maternal and neonatal death in sub-Saharan Africa. As one in every three non-facility deliveries in Nigeria is assisted by a traditional birth attendant (TBA), and the TBA's advice is often adhered to by their clients, engaging TBAs in advocacy among their clients may increase maternal and neonatal postnatal care use. This study estimates the impact of monetary incentives for maternal referrals by TBAs on early maternal and neonatal postnatal care use (within 48 h of delivery) in Nigeria. METHODS We conducted a non-blinded, individually-randomized, controlled study of 207 TBAs in Ebonyi State, Nigeria between August and December 2016. TBAs were randomly assigned with a 50-50 probability to receive $2.00 for every maternal client that attended postnatal care within 48 h of delivery (treatment group) or to receive no monetary incentive (control group). We compared the probabilities of maternal and neonatal postnatal care use within 48 h of delivery in treatment and control groups in an intention-to-treat analysis. We also ascertained if the care received by mothers and newborns during these visits followed World Health Organization guidelines. RESULTS Overall, 207 TBAs participated in this study: 103 in the treatment group and 104 in the control group. The intervention increased the proportion of maternal clients of TBAs that reported attending postnatal care within 48 h of delivery by 15.4 percentage points [95% confidence interval (CI): 7.9-22.9]. The proportion of neonatal clients of TBAs that reportedly attended postnatal care within 48 h of delivery also increased by 12.6 percentage points [95% CI: 5.9-19.3]. However, providers often did not address the issues that may have led to maternal and newborn postnatal complications during these visits. CONCLUSIONS We show that motivating TBAs using monetary incentives for maternal postnatal care use can increase skilled care use after delivery among their maternal and neonatal clients, who have a higher risk of mortality because of their exposure to unskilled birth attendance. However, improving the quality of care is key to ensuring maternal and neonatal health gains from postnatal care attendance. TRIAL REGISTRATION The trial was retrospectively registered in clinicaltrials.gov ( NCT02936869 ) on October 18, 2016.
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Affiliation(s)
- Adanna Chukwuma
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington, DC 20433 USA
| | - Chinyere Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Thomas J. Bossert
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Jessica Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
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Okawa S, Win HH, Leslie HH, Nanishi K, Shibanuma A, Aye PP, Jimba M. Quality gap in maternal and newborn healthcare: a cross-sectional study in Myanmar. BMJ Glob Health 2019; 4:e001078. [PMID: 30997160 PMCID: PMC6441248 DOI: 10.1136/bmjgh-2018-001078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/06/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Access to maternal and newborn healthcare has improved in Myanmar. However, regular contact with skilled care providers does not necessarily result in quality care. We assessed adequate contact made by women and newborns with skilled care providers, reception of high-quality care and quality-adjusted contacts during antenatal care (ANC), peripartum care (PPC) and postnatal care (PNC) in Myanmar. Methods This cross-sectional study was conducted in a predominantly urban township of Yangon and a predominantly rural township of Ayeyawady in March 2016. We collected data from 1500 women. We measured quality-adjusted contact, which refers to adequate contact with high-quality care, as follows: ≥4 ANC contacts and receiving 11–14 of 14 intervention items; facility-based delivery assisted by skilled care providers, receiving 7 of 7 PPC intervention items; and receiving the first PNC contact ≤24 hours postpartum and ≥2 additional contacts, and receiving 16–17 of 17 intervention items. Using multilevel logistic regression analysis with a random intercept at cluster level, we identified factors associated with adequate contact and high-quality ANC, PPC and PNC. Results The percentage of crude adequate contact was 60.9% for ANC, 61.3% for PPC and 11.5% for PNC. However, the percentage of quality-adjusted contact was 14.6% for ANC, 15.2% for PPC and 3.6% for PNC. Adequate contact was associated with receiving high-quality care at ANC, PPC and PNC. Being a teenager, low educational level, multiparity and low level in the household wealth index were negatively associated with adequate contact with healthcare providers for ANC and PPC. Receiving a maternal and child health handbook was positively associated with adequate contact for ANC and PPC, and with receiving high-quality ANC, PPC and PNC. Conclusion Women and newborns do not receive quality care during contact with skilled care providers in Myanmar. Continuity and quality of maternal and newborn care programmes must be improved.
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Affiliation(s)
- Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, The Republic of the Union of Myanmar
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Phyu Phyu Aye
- Department of Public Health, Ministry of Health and Sports, Naypyidaw, The Republic of the Union of Myanmar
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Larson E, Gage AD, Mbaruku GM, Mbatia R, Haneuse S, Kruk ME. Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster-randomised study in rural Tanzania. Trop Med Int Health 2019; 24:636-646. [PMID: 30767422 PMCID: PMC6499631 DOI: 10.1111/tmi.13220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives Reduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub‐optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth. Methods In this cluster‐randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in‐service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference‐in‐differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation. Results The intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup. Conclusions We attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.
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Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anna D Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Fisseha G, Berhane Y, Worku A. Quality of intrapartum and newborn care in Tigray, Northern Ethiopia. BMC Pregnancy Childbirth 2019; 19:37. [PMID: 30658706 PMCID: PMC6339373 DOI: 10.1186/s12884-019-2184-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality intrapartum and newborn care is considered to be poor in Sub-Saharan Africa. However, studies done in Ethiopia are limited. Therefore, this study was conducted to assess the magnitude and factors associated with quality intrapartum and newborn care in Tigray, Northern Ethiopia. METHODS Facility based survey was conducted from December 2014 to February 2015 in Tigray, Northern Ethiopia. The quality of intrapartum care provided by a total of 106 skilled birth attendants to 216 labouring mothers and newborns were observed during childbirth in the health facilities. Standardized questionnaires and checklist were utilized to collect data. Quality of intrapartum service was measured using standard intrapartum criteria. Thus, good quality service was considered if the mother and newborn scored 75% or more of the intrapartum criteria during childbirth. Binary and multiple logistic regression model was used to determine the factors associated with quality intrapartum and newborn care services. RESULTS 29.2% of mothers and 67.6% newborns received good quality care during intrapartum and immediate postpartum periods respectively. However, only 47.2% of mothers and newborns received a friendly care during childbirths. The independent predictors of quality intrapartum and newborn care were the appropriate use of partograph (AOR 3.92; 95% CI 1.78, 8.63), friendly maternal and newborn care services (AOR 7.9; 95% CI 3.59, 17.33), more than two years working experience (AOR 0.31; 95% CI 0.13, 0.73) and using services in different Zones in the study area. CONCLUSIONS The quality intrapartum care is poor in the study area and it is associated with inappropriate use of partograph, unfriendly care, and experience of health providers. Scaling up obstetric service, continuous training and motivation of service providers and revising the criterion for accreditation of service providers are important.
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Affiliation(s)
- Girmatsion Fisseha
- Mekelle University, School of Public Health, P.O.BOX: 1871, Mekelle, Ethiopia.
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
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El-Sayed AM, Vail D, Kruk ME. Ineffective insurance in lower and middle income countries is an obstacle to universal health coverage. J Glob Health 2018; 8:020402. [PMID: 30140432 PMCID: PMC6076567 DOI: 10.7189/jogh.08.020402] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Recent health policy efforts have sought to promote universal health coverage (UHC) as a means of providing affordable access to health services to populations. However, insurance schemes are heterogeneous, and some schemes may not provide necessary services to those covered. We explored the prevalence and determinants of ineffective insurance across 42 lower and middle income countries (LMICs) from the 2002-2004 World Health Survey. METHODS Respondents were defined as having ineffective health insurance if they reported being insured and: were forced to borrow or sell personal items to pay for health services; had an untreated chronic condition; or had recently delivered a child outside of a skilled health facility (women only). RESULTS Among the insured, 13% had ineffective insurance, which was most commonly due to having to borrow or sell to pay for health care. The likelihood of ineffective insurance was lowest in upper-middle income countries and higher in other lower-middle and low-income countries. Ineffective insurance also decreased with family wealth and was higher among rural residents. CONCLUSIONS Our findings suggest that a high proportion of insurance in LMICs is ineffective, particularly among those who need it most, and that attention should be paid to effectiveness when defining health insurance in policy conversations about UHC.
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Affiliation(s)
- Abdulrahman M El-Sayed
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Daniel Vail
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Margaret E Kruk
- Department of Global Health & Population, TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Sheffel A, Karp C, Creanga AA. Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middle-income countries. BMJ Glob Health 2018; 3:e001011. [PMID: 30555726 PMCID: PMC6267320 DOI: 10.1136/bmjgh-2018-001011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/15/2018] [Accepted: 09/07/2018] [Indexed: 12/03/2022] Open
Abstract
Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO's Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework's cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework's provision and experience of care dimensions would fill significant data gaps in LMICs.
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Affiliation(s)
- Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kifle MM, Kesete HF, Gaim HT, Angosom GS, Araya MB. Health facility or home delivery? Factors influencing the choice of delivery place among mothers living in rural communities of Eritrea. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:22. [PMID: 30348219 PMCID: PMC6196428 DOI: 10.1186/s41043-018-0153-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/08/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND In Eritrea, despite high antenatal care (ANC) use, utilization of health facilities for child birth is still low and with marked variations between urban and rural areas. Understanding the reasons behind the poor use of these services in a rural setting is important to design targeted strategies and address the challenge contextually. This study aimed to determine factors that influence women's choice of delivery place in selected rural communities in Eritrea. METHODS A cross-sectional survey of 309 women aged 15-49 years with a delivery in the last 1-2 years prior to the survey was conducted in a randomly selected villages of Hadish Adi, Serea, Genseba, Kelay Bealtat, Dirko, Mai Leham, Kudo Abour, Adi Koho, and Leayten. Data were collected using an interviewer administered questionnaire. Chi-square tests were used to explore association between variables. Using odds ratios with 95% confidence intervals with p < 0.05 taken as statically significant association, bivariate and multivariate logistic regression analysis were used to identify factors that affect the choice of delivery place. RESULTS Overall, 75.4% of the respondents delivered their last child at home while 24.6% delivered in health facility. Women whose husband's had no formal education were less likely [AOR = 0.02; 95% CI 0.01-0.54] to deliver in health facility. Women who had joint decision-making with husbands on delivery place [AOR = 5.42; 95% CI 1.78-16.49] and women whose husbands choose health facility delivery [AOR = 2.32; 95% CI 1.24-5.11] were more likely to have health facility delivery. Respondents who had medium wealth status [AOR = 3.78; 95% CI 1.38-10.37] have access to health facility within 2 km distance [AOR = 14.67; 95% CI 2.30-93.45] and women with traditional means of transport [AOR = 9.78; 95% CI 1.23-77.26] were also more likely to deliver in health facility. Women who read newspaper daily or infrequently had three [AOR = 3.77; 95% CI 1.12-4.04] and almost three times [AOR = 2.95; 95% CI 1.01-8.59] higher odds of delivering in health facility. Similarly, women who have knowledge about complications during delivery [AOR = 4.39; 95% CI 1.63-11.83], good perception on the quality of care they received [AOR = 9.52; 95% CI 1.91-47.50], had previous facility delivery [AOR = 2.69; 95% CI 0.94-7.68], have negative experiences of delivery outcomes in her community [AOR = 1.31; 95% CI 1.00-4.96], and women who perceive home delivery as life threatening [AOR = 1.84; 95% CI 1.46-3.38] were more likely to deliver in health facility. CONCLUSION To increase health facility delivery, raising women's awareness on the benefits of delivering in health facility, male involvement in the use of maternal health services, increasing women decision-making power, addressing common barriers of lack of transport, and compensations for transport expenses to alleviate the cost of transport are recommended. Efforts to shorten distance to reach health facility and health education focusing on the potential threats of delivering at home at the individual and community level can have substantial contribution to increase health facility delivery in rural communities of Eritrea.
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Affiliation(s)
- Meron Mehari Kifle
- Department of Epidemiology and Biostatistics, School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea.
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Brenner S, Mazalale J, Wilhelm D, Nesbitt RC, Lohela TJ, Chinkhumba J, Lohmann J, Muula AS, De Allegri M. Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi. BMC Health Serv Res 2018; 18:791. [PMID: 30340491 PMCID: PMC6194711 DOI: 10.1186/s12913-018-3589-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/01/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Results-based financing (RBF) describes health system approaches addressing both service quality and use. Effective coverage is a metric measuring progress towards universal health coverage (UHC). Although considered a means towards achieving UHC in settings with weak health financing modalities, the impact of RBF on effective coverage has not been explicitly studied. METHODS Malawi introduced the Results-Based Financing For Maternal and Neonatal Health (RBF4MNH) Initiative in 2013 to improve quality of maternal and newborn health services at emergency obstetric care facilities. Using a quasi-experimental design, we examined the impact of the RBF4MNH on both crude and effective coverage of pregnant women across four districts during the two years following implementation. RESULTS There was no effect on crude coverage. With a larger proportion of women in intervention areas receiving more effective care over time, the overall net increase in effective coverage was 7.1%-points (p = 0.07). The strongest impact on effective coverage (31.0%-point increase, p = 0.02) occurred only at lower cut-off level (60% of maximum score) of obstetric care effectiveness. Design-specific and wider health system factors likely limited the program's potential to produce stronger effects. CONCLUSION The RBF4MNH improved effective coverage of pregnant women and seems to be a promising reform approach towards reaching UHC. Given the short study period, the full potential of the current RBF scheme has likely not yet been reached.
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Affiliation(s)
- Stephan Brenner
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Jacob Mazalale
- Department of Economics, Chancellor College, University of Malawi, Zomba, Malawi
| | - Danielle Wilhelm
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Robin C Nesbitt
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Terhi J Lohela
- Department of Public Health, University of Helsinki, P.O. Box 20, FI-00014 Helsinki, Finland
| | | | - Julia Lohmann
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Adamson S Muula
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Shibanuma A, Yeji F, Okawa S, Mahama E, Kikuchi K, Narh C, Enuameh Y, Nanishi K, Oduro A, Owusu-Agyei S, Gyapong M, Asare GQ, Yasuoka J, Ansah EK, Hodgson A, Jimba M. The coverage of continuum of care in maternal, newborn and child health: a cross-sectional study of woman-child pairs in Ghana. BMJ Glob Health 2018; 3:e000786. [PMID: 30233827 PMCID: PMC6135430 DOI: 10.1136/bmjgh-2018-000786] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/18/2018] [Accepted: 06/09/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction The continuum of care has recently received attention in maternal, newborn and child health. It can be an effective policy framework to ensure that every woman and child receives timely and appropriate services throughout the continuum. However, a commonly used measurement does not evaluate if a pair of woman and child complies with the continuum of care. This study assessed the continuum of care based on two measurements: continuous visits to health facilities (measurement 1) and receiving key components of services (measurement 2). It also explored individual-level and area-level factors associated with the continuum of care achievement and then investigated how the continuum of care differed across areas. Methods In this cross-sectional study in Ghana in 2013, the continuum of care achievement and other characteristics of 1401 pairs of randomly selected women and children were collected. Multilevel logistic regression was used to estimate the factors associated with the continuum of care and its divergence across 22 areas. Results Throughout the pregnancy, delivery and post-delivery stages, 7.9% of women and children achieved the continuum of care through continuous visits to health facilities (measurement 1). Meanwhile, 10.3% achieved the continuum of care by receiving all key components of maternal, newborn and child health services (measurement 2). Only 1.8% of them achieved it under both measurements. Women and children from wealthier households were more likely to achieve the continuum of care under both measurements. Women’s education and complications were associated with higher continuum of care services-based achievement. Variance of a random intercept was larger in the continuum of care services-based model than the visit-based model. Conclusions Most women and children failed to achieve the continuum of care in maternal, newborn and child health. Those who consistently visited health facilities did not necessarily receive key components of services.
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Affiliation(s)
- Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Francis Yeji
- Navrongo Health Research Centre, Navrongo, Ghana
| | - Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Clement Narh
- Dodowa Health Research Centre, Dodowa, Ghana.,School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | | | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Evelyn Korkor Ansah
- Research and Development Division, Ghana Health Service, Accra, Ghana.,Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Augusto O, Keyes EE, Madede T, Abacassamo F, de la Corte P, Chilundo B, Bailey PE. Progress in Mozambique: Changes in the availability, use, and quality of emergency obstetric and newborn care between 2007 and 2012. PLoS One 2018; 13:e0199883. [PMID: 30020958 PMCID: PMC6051588 DOI: 10.1371/journal.pone.0199883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/17/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Maternal mortality in Mozambique has not declined significantly in the last 10-15 years, plateauing around 480 maternal deaths per 100,000 live births. Good quality antenatal care and routine and emergency intrapartum care are critical to reducing preventable maternal and newborn deaths. MATERIALS AND METHODS We compare the findings from two national cross-sectional facility-based assessments conducted in 2007 and 2012. Both were designed to measure the availability, use and quality of emergency obstetric and neonatal care. Indicators for monitoring emergency obstetric care were used as were descriptive statistics. RESULTS The availability of facilities providing the full range of obstetric life-saving procedures (signal functions) decreased. However, an expansion in the provision of individual signal functions was highly visible in health centers and health posts, but in hospitals, performance was less satisfactory, with proportionally fewer hospitals providing assisted vaginal delivery, obstetric surgery and blood transfusions. All other key indicators showed signs of improvements: the institutional delivery rate, the cesarean delivery rate, met need for emergency obstetric care (EmOC), institutional stillbirth and early neonatal death rates, and cause-specific case fatality rates (CFRs). CFRs for most major obstetric complications declined between 17% and 69%. The contribution of direct causes to maternal deaths decreased while the proportion of indirect causes doubled during the five-year interval. CONCLUSIONS The indicator of EmOC service availability, often used for planning and developing EmONC networks, requires close examination. The standard definition can mask programmatic weaknesses and thus, fails to inform decision makers of what to target. In this case, the decline in the use of assisted vaginal delivery explained much of the difference in this indicator between the two surveys, as did faltering hospital performance. Despite this backsliding, many signs of improvement were also observed in this 5-year period, but indicator levels continue below recommended thresholds. The quality of intrapartum care and the adverse consequences from infectious diseases during pregnancy point to priority areas for programmatic improvement.
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Affiliation(s)
- Orvalho Augusto
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
- * E-mail:
| | - Emily E. Keyes
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
| | - Tavares Madede
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Fátima Abacassamo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | | | - Baltazar Chilundo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Patricia E. Bailey
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
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