Determinants of childbirth care quality along the care continuum in limited resource settings: A structural equation modeling analysis of cross-sectional data from Burkina Faso and Côte d’Ivoire

Abstract

Introduction Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to poor childbirth care quality. The reason why women delivering in health facilities do not always receive care of an adequate standard is unclear. We assessed the determinants of childbirth care quality along the care continuum by means of different approaches. Methods A health facility-based cross-sectional study with a direct observation of health care workers’ practices while caring for mother–newborn pairs was carried out in Burkina Faso and Côte d’Ivoire. The performance of a set of essential best practices (EBPs) was assessed in each birth event at the admission, prepushing and immediate postpartum stages. A quality score, in the form of the additive sum of EBPs effectively delivered, was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to assess the determinants of care quality at each stage and the relationships of the quality delivered at the different stages, respectively. Results A total of 532 and 627 mother–newborn pairs were evaluated in Burkina Faso and Côte d’Ivoire, respectively. In both countries, delivery care quality varied significantly at all stages between health districts. Predelivery care quality was consistently higher in referral hospitals than in primary health care facilities (incident rate ratio (IRR) = 1.02, p < 0.05, and IRR = 1.10, p < 0.05, respectively, for Burkina Faso and Côte d’Ivoire). Quality at admission was poorer among nurses than among midwives in Burkina Faso (IRR = 0.81, p < 0.001). Quality at the admission and predelivery stages was positively correlated with immediate postpartum care quality (β = 0.48, p < 0.001, and β = 0.29, p < 0.001, respectively). Conclusion Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.

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

“…Referral hospital had both direct (β=0.43, 95% CI 0.10, 0.76) and indirect (β=2.00, 95% CI 1.26, 2.75) positive effects on the quality of intrapartum care that resulted in a positive total effect (β=1.44, 95% CI 1.68, 2.75). This result is consistent with the study done in Burkina Faso and Côte d’Ivoire, 26 Sweden 49 and Nigeria. 50 The difference in performance at the different stages of health facilities (referral and primary) may be a result of hospitals housing senior professionals, many of whom may be connected to academic institutions.…”

“…The quality of routine childbirth care during the immediate postpartum care significantly increased with the provider’s years of working experience (β=0.19, 95% CI 0.11, 0.28). This finding is supported by a study conducted in Burkina Faso and Côte d’Ivoire26 which revealed that a year of experience was significantly associated with having good-quality childbirth care. This may be due to more experienced health workers being more likely to have benefited from quality improvement initiatives (inservice training, supportive supervision, etc) that have reinforced their skills and competencies 32…”

“…This result indicates that when age increases, the respect and care for labouring mothers also increase, since respecting older people is part of the culture of most Ethiopian communities 44. However, the effect of maternal age on the quality of childbirth care was insignificant in previous studies 26 32. This finding suggests that due attention should be given to women who are below 24 years of age.…”

“…Despite an increase in the number of mothers who visit delivery facilities, there is a mismatch between supply and demand for quality of care due to a shortage of qualified providers, knowledge gaps, lack of access to evidence-based information and lack of motivation among healthcare workers 4 26. As a result, identifying the possible determinants of quality of care during this important period could have a significant impact on maternal and infant survival, as well as inform concerned bodies about where improvements must be made to enhance the effectiveness of health services.…”

“…As a result, identifying the possible determinants of quality of care during this important period could have a significant impact on maternal and infant survival, as well as inform concerned bodies about where improvements must be made to enhance the effectiveness of health services. Previous research has mostly focused on the quality of emergency obstetric and newborn care only or the quality of routine care at a specific point (intrapartum or immediate postpartum period only) during the course of childbirth,17 27 and has rarely looked at the quality of routine care across the continuum of care 4 26. This study applied the methodology proposed by Tripathi et al 21 to evaluate the quality of childbirth care across the continuum, using an appropriate statistical model known as generalised structural equation modelling (GSEM).…”