Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis

Bayou, Negalign Berhanu; Grant, Liz; Riley, Simon; Bradley, Elizabeth H.

doi:10.1186/s12884-022-04850-5

Cited by 6 publications

(8 citation statements)

References 31 publications

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“…While essential equipment and medicines for mothers and equipment for newborns were frequently available for most deliveries, the delivery care guidelines, trained providers, and essential medicines for newborns were unavailable for many deliveries. Gaps in structural factors of QoC are common across LMICs; for example, in Ethiopia, one-third of HFs assessed in 2022 had low readiness to provide routine labor and delivery care, with only 52.2% of the hospitals having essential medicines, equipment, and supplies [ 16 ]. While the average score for S2 “actionable health information systems” was 65.3%, S3 “functional referral system” was almost universally achieved.…”

Section: Discussionmentioning

confidence: 99%

Standards of care and determinants of women’s satisfaction with delivery services in Nepal: a multi-perspective analysis using data from a health facility-based survey

Tuladhar,

Delius,

Siebeck

et al. 2024

BMC Pregnancy Childbirth

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Background Compliance with standards of care is required for sustained improvement in the quality of delivery services. It thus represents a key challenge to improving maternal survival and meeting the Sustainable Development Goal (SDG) target of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. This study examines the extent to which normal low-risk health facility deliveries in Nepal meet the standards of quality of care and assesses the effect of the standards of quality of care and various contextual factors on women’s satisfaction with the services they receive. Methods Drawing on the 2021 Nepal Health Facility Survey, the sample comprised 320 women who used health facilities for normal, low-risk delivery services. A weighted one-sample t-test was applied to examine the proportion of deliveries meeting the eight standards of care. Women’s overall satisfaction level was computed from seven satisfaction variables measured on a Likert scale, using principal component analysis. The composite measure was then dichotomized. Binary logistic regression was used to analyze the determinants of women’s satisfaction with delivery care services. Results Deliveries complying with the eight standards of care and its 53 indicators varied widely; output indicators were more frequently met than input indicators. Of the eight standards of care, the “functional referral system” performed highest (92.0%), while “competent, motivated human resources” performed the least (52.4%). Women who were attended by a provider when they called for support (AOR: 5.29; CI: 1.18, 23.64), who delivered in health facilities that displayed health statistics (AOR 3.16; CI: 1.87, 5.33), who experienced caring behaviors from providers (AOR: 2.59; CI: 1.06, 6.30) and who enjoyed audio-visual privacy (AOR 2.13; CI: 1.04, 4.38) had higher satisfaction levels compared to their counterparts. The implementation of the Maternity Incentive Scheme and presence of a maternal waiting room in health facilities, however, were associated with lower satisfaction levels. Conclusions Nepal performed moderately well in meeting the standards of care for normal, low-risk deliveries. To meet the SDG target Nepal must accelerate progress. It needs to focus on people-centered quality improvement to routinely assess the standards of care, mobilize available resources, improve coordination among the three tiers of government, and implement high-impact programs.

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Section: Discussionmentioning

confidence: 99%

Standards of care and determinants of women’s satisfaction with delivery services in Nepal: a multi-perspective analysis using data from a health facility-based survey

Tuladhar,

Delius,

Siebeck

et al. 2024

BMC Pregnancy Childbirth

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“…This also shows that facility delivery is not a guarantee that women’s demand for contraceptives will be met due to the multidimensional nature of the problem. Furthermore, evidence also showed substantial capacity gaps in the Ethiopian health system, challenging the provision of quality routine labor and delivery care services [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Machine learning modeling for identifying predictors of unmet need for family planning among married/in-union women in Ethiopia: Evidence from performance monitoring and accountability (PMA) survey 2019 dataset

Kebede,

Mamo,

Adem

et al. 2023

PLOS Digit Health

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Unmet need for contraceptives is a public health issue globally that affects maternal and child health. Reducing unmet need reduces the risk of abortion or childbearing by preventing unintended pregnancy. The unmet need for family planning is a frequently used indicator for monitoring family planning programs. This study aimed to identify predictors of unmet need for family planning using advanced machine learning modeling on recent PMA 2019 survey data. The study was conducted using secondary data from PMA Ethiopia 2019 cross-sectional household and female survey which was carried out from September 2019 to December 2019. Eight machine learning classifiers were employed on a total weighted sample of 5819 women and evaluated using performance metrics to predict and identify important predictors of unmet need of family planning with Python 3.10 version software. Data preparation techniques such as removing outliers, handling missing values, handling unbalanced categories, feature engineering, and data splitting were applied to smooth the data for further analysis. Finally, Shapley Additive exPlanations (SHAP) analysis was used to identify the top predictors of unmet need and explain the contribution of the predictors on the model’s output. Random Forest was the best predictive model with a performance of 85% accuracy and 0.93 area under the curve on balanced training data through tenfold cross-validation. The SHAP analysis based on random forest model revealed that husband/partner disapproval to use family planning, number of household members, women education being primary, being from Amhara region, and previously delivered in health facility were the top important predictors of unmet need for family planning in Ethiopia. Findings from this study suggest various sociocultural and economic factors might be considered while implementing health policies intended to decrease unmet needs for family planning in Ethiopia. In particular, the husband’s/partner’s involvement in family planning sessions should be emphasized as it has a significant impact on women’s demand for contraceptives.

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“…Hospital-level independent variables included teaching hospital status, mean number of births in the hospital in the previous year, number of fulltime skilled attendants in the L&D ward on the assessment day, whether the hospital had offered refresher training on L&D care in the previous 12 months, and the extent of resources available (measured on a 0-100% scale) to provide quality L&D care as defined by the Ethiopian Ministry of Health (16). Details on the measure of resources available have been previously described (17).…”

Section: Independent Variablesmentioning

confidence: 99%

“…12 months. The average score(17) assessing the extent of resources available to 214 provide quality of L&D care was 68.2%, with a SD of 15.9 percentage points.…”

mentioning

confidence: 99%

Quality of Labour and Delivery Care Process and Associated Factors in Government Hospitals of Ethiopia: a multilevel analysis

Bayou

Grant

Riley

et al. 2023

Preprint

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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-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 of resources available (measured on a 0-100% scale) to provide quality L&D care as defined by the Ethiopian Ministry of Health in 2014. The outcome was measured with a quality of L&D care score (scale 0 to 100) based on adherence to L&D care standards, which had been introduced by the Ethiopian Ministry of Health in 2014.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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Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis

Cited by 6 publications

References 31 publications

Standards of care and determinants of women’s satisfaction with delivery services in Nepal: a multi-perspective analysis using data from a health facility-based survey

Standards of care and determinants of women’s satisfaction with delivery services in Nepal: a multi-perspective analysis using data from a health facility-based survey

Machine learning modeling for identifying predictors of unmet need for family planning among married/in-union women in Ethiopia: Evidence from performance monitoring and accountability (PMA) survey 2019 dataset

Quality of Labour and Delivery Care Process and Associated Factors in Government Hospitals of Ethiopia: a multilevel analysis

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