Format

Send to

Choose Destination
BMC Pregnancy Childbirth. 2016 Aug 30;16:255. doi: 10.1186/s12884-016-1047-0.

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

Author information

1
Population Council, New York, NY, USA. ablanc@popcouncil.org.
2
Population Council, Mexico City, Mexico.
3
Population Council, New York, NY, USA.

Abstract

BACKGROUND:

The 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.

METHODS:

We 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).

RESULTS:

Five 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.

CONCLUSION:

Women 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.

KEYWORDS:

Indicators; Intervention coverage; Maternal and newborn health; Measurement; Quality of care; Skilled birth attendance; Validation

PMID:
27577266
PMCID:
PMC5006493
DOI:
10.1186/s12884-016-1047-0
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center