Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care

Abstract

BackgroundThe majority of births in Mexico take place in a health facility and are attended by a skilled birth attendant, yet maternal mortality has not declined to anticipated levels. Coverage estimates of skilled attendance and other maternal and newborn interventions often rely on women’s self-report through a population-based survey, the accuracy of which is not well established.MethodsWe used a facility-based design to validate women’s report of skilled birth attendance, as well as other key elements of maternal, newborn intrapartum, and immediate postnatal care. Women’s reports of labor and delivery care were collected by exit interview prior to hospital discharge and were compared against direct observation by a trained third party in a Mexican public hospital (n = 597). For each indicator, validity was assessed at the individual level using the area under the receiver operating curve (AUC) and at the population level using the inflation factor (IF).ResultsFive of 47 indicators met both validation criteria (AUC > 0.60 and 0.75 < IF < 1.25): urine sample screen, injection or IV medication received during labor, before the birth of the baby (i.e., uterotonic for either induction or augmentation of labor), episiotomy, excessive bleeding, and receipt of blood products. An additional 9 indicators met criteria for the AUC and 18 met criteria for the IF. A skilled attendant indicator had high sensitivity (90.1 %: 95 % CI: 87.1–92.5 %), low specificity (14.0 %: 95 % CI: 5.8–26.7 %) and was suitable for population-level estimation only.ConclusionWomen are able to give valid reports on some aspects of the content of care, although questions regarding the indication for interventions are less likely to be known. Questions that include technical terms or refer to specific time periods tended to have lower response levels. A key aspect of efforts to improve maternal and newborn health requires valid measurement of women’s access to maternal and newborn health interventions and the quality of such services. Additional work on improving measurement of population coverage indicators is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1047-0) contains supplementary material, which is available to authorized users.

Beyond Health System Contact: Measuring and Validating Quality of Childbirth Care Indicators in Primary Level Facilities of Northern Ethiopia

“…Besides, Mothers may have under reported negative experiences at a facility due to concerns about providers abandoning proper care for their subsequent visit in retaliation for these comments." We also found low sensitivity and high specificity for reported excessive bleeding (hemorrhage); this finding corresponds with levels found among women delivering in Mexico, Indonesia, Benin and the Philippines respectively [9,[26][27][28]. However, these results differ from women's reporting in Ghana [29].Taken together, the findings suggest that women's understanding and recall of the presence of a companion of choice and obstetric complications experienced may vary by clinical and cultural context, and settings.…”

“…Providers were observed by a third party consisting of trained data collectors using a structured checklist. An indicator matrix or structured checklist [Appendix 2] was developed from the Ethiopian basic emergency obstetrics guidelines [20] and published literature [4,5,9]. The interview questionnaires were translated into the appropriate local language "Tigrigna" and underwent minor modifications to improve local understanding and clarity for participants.…”

“Every Newborn-BIRTH” protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania

“…Comparison of the reported indicator to an external data source "gold standard" is recommended [45]. Previous validation studies have mainly focused on population-based intervention coverage indicators for use in household surveys [25,[46][47][48]. Observational studies to determine accuracy of facility registers in high burden settings have typically focused on outcome indicators [29].…”

Childbirth care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys between 1995 and 2014 examining use of care, provider mix and immediate postpartum care content

“…Given the systemic issues influencing quality of care in Egypt [58] and documented substandard intrapartum practices [34,35], tools that can capture better measures of quality of care during and after delivery should be developed. However, such data and indicators are unlikely to be collected from women themselves, due to poor validity [64][65][66][67]. Finally, it was not possible to assess whether women in public hospitals were in a public or a paying/private section.…”