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Abebaw WA, Wolde HF, Tilahun WM, Gebreegziabher ZA, Teshome DF. 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. BMJ Open 2024; 14:e073199. [PMID: 38580371 PMCID: PMC11002431 DOI: 10.1136/bmjopen-2023-073199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the quality of childbirth care and its determinants along the continuum of care in Gondar town public health facility in Ethiopia. DESIGN An institution-based, cross-sectional study was employed. Completed data were imported to Stata V.16 for cleaning and analysis. A generalised structural equation model was employed to examine the relationships along the continuum of childbirth care and to determine the factors affecting the quality of childbirth care. SETTING AND PARTICIPANTS This study was conducted among a total of 865 women who delivered in the public health facility of Gondar, Ethiopia, from 19 May to 30 June 2022. RESULTS The study revealed the proportion of good-quality childbirth care during admission, intrapartum and immediate postpartum period was 59% (95% CI 55.7, 62.4), 76.8% (95% CI 73.8, 79.5) and 45% (95% CI 41.7, 48.5), respectively. Postsecondary educational status of mothers (β=0.60, 95% CI 0.16, 1.04) and maternal age of 25-35 (β=0.68, 95% CI 0.33, 1.02) were predictors of quality of care at admission. Referral hospital (β=0.43, 95% CI 0.10, 0.76), presence of guidelines (β=1.36, 95% CI 0.72, 1.99) and provider age of 25-35 (β=0.61, 95% CI 0.12, 1.10) affected the quality of care during the intrapartum period. Urban residence (β=0.52, 95% CI 0.12, 0.93), skilled birth attendant experience (β=0.19, 95% CI 0.11, 0.28) and number of delivery couches (β=-0.29, 95% CI -0.44, -0.13) had significant associations with the quality of childbirth care during the immediate postpartum period. CONCLUSIONS Although our study found improvements in the quality of childbirth care along the continuum compared with previous studies, more workers are needed to alleviate the problem of poor-quality service. Different maternal, provider and facility factors were found to be predictors of the quality of childbirth care.
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Affiliation(s)
| | - Haileab Fekadu Wolde
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | | | - Destaw Fetene Teshome
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Millogo T, Kourouma RK, Méda BI, Agbre-Yace ML, Dosso A, Yaméogo MWE, Kouanda S. 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. BMC Pregnancy Childbirth 2021; 21:848. [PMID: 34965869 PMCID: PMC8715591 DOI: 10.1186/s12884-021-04328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Tieba Millogo
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso. .,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.
| | - Raïssa Kadidiatou Kourouma
- Institut National de Santé Publique (INSP-Côte d'Ivoire), Abidjan, Côte d'Ivoire.,Cellule de Recherche en Santé de la Reproduction, Abidjan, Côte d'Ivoire
| | - Bertrand Ivlabéhiré Méda
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso.,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Marie Laurette Agbre-Yace
- Institut National de Santé Publique (INSP-Côte d'Ivoire), Abidjan, Côte d'Ivoire.,Cellule de Recherche en Santé de la Reproduction, Abidjan, Côte d'Ivoire
| | - Abdul Dosso
- Cellule de Recherche en Santé de la Reproduction, Abidjan, Côte d'Ivoire
| | - Maurice W E Yaméogo
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso.,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso.,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
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Govule P, Baumann S, Dossou JP, Calvert C, Goufodji S, Mehrtash H, Tuncalp Ö, Adu-Bonsaffoh K, Compaore R, Filippi V. Experiences of women seeking care for abortion complications in health facilities: Secondary analysis of the WHO Multi-Country Survey on Abortion in 11 African countries. Int J Gynaecol Obstet 2021; 156 Suppl 1:44-52. [PMID: 34866183 DOI: 10.1002/ijgo.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite evidence of acute and long-term consequences of suboptimal experiences of care, standardized measurements across countries remain limited, particularly for postabortion care. We aimed to determine the proportion of women reporting negative experiences of care for abortion complications, identify risk factors, and assess the potential association with complication severity. METHODS Data were sourced from the WHO Multi-Country Survey on Abortion for women who received facility-based care for abortion complications in 11 African countries. We measured women's experiences of care with eight questions from an audio computer-assisted self-interview related to respect, communication, and support. Multivariable generalized estimating equations were used for analysis. RESULTS There were 2918 women in the study sample and 1821 (62%) reported at least one negative experience of postabortion care. Participants who were aged under 30 years, single, of low socioeconomic status, and economically dependent had higher odds of negative experiences. Living in West or Central Africa, rather than East Africa, was also associated with reportedly worse care. The influence of complication severity on experience of care appeared significant, such that women with moderate and severe complications had 12% and 40% higher odds of reporting negative experiences, respectively. CONCLUSION There were widespread reports of negative experiences of care among women receiving treatment for abortion complications in health facilities. Our findings contribute to the scant understanding of the risk factors for negative experiences of postabortion care and highlight the need to address harmful provider biases and behaviors, alleviate health system constraints, and empower women in demanding better care.
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Affiliation(s)
- Philip Govule
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Sasha Baumann
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Scotland, UK
| | - Sourou Goufodji
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Bénin
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tuncalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana.,Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Rachidatou Compaore
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Véronique Filippi
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Brown KK, Boateng GO, Ossom-Williamson P, Haygood L. Defining, conceptualizing, and measuring perceived maternal care quality in low- to high-income countries: a scoping review protocol. Syst Rev 2021; 10:61. [PMID: 33627182 PMCID: PMC7903867 DOI: 10.1186/s13643-021-01608-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health practitioners and researchers must be able to measure and assess maternal care quality in facilities to monitor, intervene, and reduce global maternal mortality rates. On the global scale, there is a general lack of consensus on how maternal care quality is defined, conceptualized, and measured. Much of the literature addressing this problem has focused primarily on defining, conceptualizing, and measuring clinical indicators of maternal care quality. Less attention has been given in this regard to perceived maternal care quality among women which is known to influence care utilization and adherence. Therefore, there is a need to map the literature focused on defining, conceptualizing, and measuring perceived maternal care quality across low-, middle-, and high-income country contexts. METHODS This scoping review protocol will follow the Arksey and O'Malley methodological framework. A comprehensive search strategy will be used to search for articles published from inception to 2020 in Ovid MEDLINE, Embase, AMED, and WHO Global Index Medicus. Gray literature will be included. Two independent reviewers will screen articles by title and abstract, then by full-text based on pre-determined inclusion/exclusion criteria. A third reviewer will arbitrate any discrepancies. This protocol outlines a four-step analytic approach that includes numerical, graphical, tabular, and narrative summaries to provide a comprehensive description of the body of literature. DISCUSSION The findings from this scoping review will provide a comprehensive overview of the existing evidence on perceived maternal care quality. The findings are expected to inform future work on building consensus around the definition and conceptualization of perceived maternal care quality, and lay the groundwork for future research aimed at developing measures of perceived maternal care quality that can be applied across country contexts. Consequently, this review may aid in facilitating coordinated efforts to measure and improve maternal care quality across diverse country contexts (i.e., low-, middle-, and high-income country contexts). REVIEW REGISTRATION This scoping review has been registered in the Open Science Framework (osf.io/k8nqh).
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Affiliation(s)
- Kyrah K Brown
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Box 19407, Arlington, TX, 76019-0407, USA.
| | - Godfred O Boateng
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Box 19407, Arlington, TX, 76019-0407, USA
| | - Peace Ossom-Williamson
- Research Data Services, UTA Libraries, University of Texas at Arlington, 702 Planetarium Place, Arlington, TX, 76019, USA
| | - Laura Haygood
- Gibson D. Lewis Health Science Library, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Patel AB, Simmons EM, Rao SR, Moore J, Nolen TL, Goldenberg RL, Goudar SS, Somannavar MS, Esamai F, Nyongesa P, Garces AL, Chomba E, Mwenechanya M, Saleem S, Naqvi F, Bauserman M, Bucher S, Krebs NF, Derman RJ, Carlo WA, Koso-ThomasMcClure MEM, Hibberd PL. Evaluating the effect of care around labor and delivery practices on early neonatal mortality in the Global Network's Maternal and Newborn Health Registry. Reprod Health 2020; 17:156. [PMID: 33256790 PMCID: PMC7708898 DOI: 10.1186/s12978-020-01010-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation's (UN's) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization's Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness. METHODS Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD's Global Network's (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery - CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0-6 of life). RESULTS A total of 150,848 live births were included in the analysis. The individual indicators varied across sites. All components were present in 19.9% births (range 0.4 to 31% across sites). Present indicators (8 components) were associated with reduced early neonatal mortality [adjusted RR (95% CI):0.81 (0.77, 0.85); p < 0.0001]. Despite an overall association between CAD and early neonatal mortality (RR < 1.0 for all early mortality): delivery by skilled birth attendant; presence of fetal heart and delayed bathing were associated with increased early neonatal mortality. CONCLUSIONS Present indicators (8 practices) of CAD were associated with a 19% reduction in the risk of neonatal death in the diverse health facilities where delivery occurred within the GN MNHR. These indicators could be monitored to identify facilities that need to improve compliance with ENC practices to reduce preventable neonatal deaths. Three of the 8 indicators were associated with increased neonatal mortality, due to baby being sick at birth. Although promising, this composite index needs refinement before use to monitor facility-based quality of care in association with early neonatal mortality. Trial registration The identifier of the Maternal Newborn Health Registry at ClinicalTrials.gov is NCT01073475.
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, India.
- Datta Meghe Institute of Medical Sciences, Wardha, India.
| | | | - Sowmya R Rao
- School of Public Health, Boston University, Boston, MA, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | | | | | | | | | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
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Weldearegay HG, Kahsay AB, Medhanyie AA, Godefay H, Petrucka P. Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study. PLoS One 2020; 15:e0234318. [PMID: 32530944 PMCID: PMC7292403 DOI: 10.1371/journal.pone.0234318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. Methods A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. Results This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (β = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (β = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (β = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (β = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (β = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (β = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (β = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers’ satisfaction (β = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers’ skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. Conclusions There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers’ level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers’ work-related burnout.
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Affiliation(s)
| | | | | | | | - Pammla Petrucka
- University of Saskatchewan, College of Nursing, Canada and Adjunct Nelson Mandela African Institute of Science and Technology, Tanzania, Canada
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