Adding Content to Contacts: Measurement of High Quality Contacts for Maternal and Newborn Health in Ethiopia, North East Nigeria, and Uttar Pradesh, India

Abstract

BackgroundFamilies in high mortality settings need regular contact with high quality services, but existing population-based measurements of contacts do not reflect quality. To address this, in 2012, we designed linked household and frontline worker surveys for Gombe State, Nigeria, Ethiopia, and Uttar Pradesh, India. Using reported frequency and content of contacts, we present a method for estimating the population level coverage of high quality contacts.Methods and FindingsLinked cluster-based household and frontline health worker surveys were performed. Interviews were conducted in 40, 80 and 80 clusters in Gombe, Ethiopia, and Uttar Pradesh, respectively, including 348, 533, and 604 eligible women and 20, 76, and 55 skilled birth attendants. High quality contacts were defined as contacts during which recommended set of processes for routine health care were met. In Gombe, 61% (95% confidence interval 50-72) of women had at least one antenatal contact, 22% (14-29) delivered with a skilled birth attendant, 7% (4-9) had a post-partum check and 4% (2-8) of newborns had a post-natal check. Coverage of high quality contacts was reduced to 11% (6-16), 8% (5-11), 0%, and 0% respectively. In Ethiopia, 56% (49-63) had at least one antenatal contact, 15% (11-22) delivered with a skilled birth attendant, 3% (2-6) had a post-partum check and 4% (2-6) of newborns had a post-natal check. Coverage of high quality contacts was 4% (2-6), 4% (2-6), 0%, and 0%, respectively. In Uttar Pradesh 74% (69-79) had at least one antenatal contact, 76% (71-80) delivered with a skilled birth attendant, 54% (48-59) had a post-partum check and 19% (15-23) of newborns had a post-natal check. Coverage of high quality contacts was 6% (4-8), 4% (2-6), 0%, and 0% respectively.ConclusionsMeasuring content of care to reflect the quality of contacts can reveal missed opportunities to deliver best possible health care.

Linking household survey and health facility data for effective coverage measures: a comparison of ecological and individual linking methods using the Multiple Indicator Cluster Survey in Côte d’Ivoire

“…This is not surprising, as contact with a health provider does not necessarily mean that the necessary interventions were delivered with quality. Other studies have also found large gaps between coverage of care-seeking and effective or quality-adjusted coverage: for example Marchant et al found in 3 settings that quality coverage of ANC was 82%-93% lower than overall ANC coverage, and quality coverage of delivery was 41%-53% lower than overall coverage of institutional delivery [7]. Leslie et al found that across 8 countries, effective coverage of ANC was 44% lower than ANC4, and effective coverage of sick child care 62% lower than care-seeking for sick children [10].…”

“…Health workers providing ANC, delivery or postnatal care, or child health services were interviewed about their training and supervision. For health workers who said that they assisted with deliveries, a module provided by the Informed Decisions for Actions in Maternal and Newborn Health (IDEAS) project was administered to ask about the interventions provided during the last delivery they assisted within the 12 months before the survey [7]. …”

“…In some cases, this is done by incorporating measures of service quality, or health benefit gained from an intervention, into household surveys [7]. A number of recent studies have combined, or “linked”, data from independently-sampled household and health facility surveys in various ways to generate measures of effective coverage [8-11].…”

Linking data sources for measurement of effective coverage in maternal and newborn health: what do we learn from individual- vs ecological-linking methods?

“…Substantial overestimates in the life-saving potential of crude coverage compared to effective coverage estimates of life-saving interventions for mothers and newborns have been shown previously, for example in data from Tanzania [12], from India, Ethiopia and Nigeria [13], as well as from DHS-based data from Rwanda, Uganda, Namibia, Kenya, Ethiopia, Ghana and Mozambique [14].…”

“…Moving beyond crude coverage to focus on effective coverage, defined as "the fraction of potential health gain that is actually delivered to the population through the health system, given its capacity", shifts the focus to acknowledge the importance of use and quality of services, in addition to need [11]. This focus on effective coverage has highlighted the quality gap in facility-based care for mothers and newborns in a variety of low and middle country settings [12][13][14].…”