Mapping the health indicators of Chhattisgarh: A public health perspective

Quality of clinical care and bypassing of primary health centers in India

In many low and middle-income countries patients often bypass the nearest government health center offering free or subsidized services and seek more expensive care elsewhere. This study examines the role of quality of care, in particular clinician competence and structural quality of the health center, on bypassing behavior. Data for this study comes from a survey of 136 primary health centers (PHCs) and 3517 individuals living in the PHC's immediate vicinity in rural Chhattisgarh, India. Overall, the majority (67%) of patients bypassed the local PHC when seeking treatment. Bypassing decreased as provider competence increased, up to a point, after which, improvements in competency did not reduce bypassing. The clinical competence of the health care provider had a greater effect on reducing bypassing compared to PHC structural quality such as the building condition and drug stock-outs. However, the regular presence of clinical providers in the PHC was associated with lower bypassing. Patients that visited the local PHC spent half as much out-of-pocket as those that were treated at private clinics. Poor patients were less likely to bypass the local PHC compared to non-poor patients. These findings suggest that improving structural quality is not sufficient to reduce bypassing of PHCs. While better provider competency can substantially reduce bypassing, beyond a threshold competency level there is little effect. Efforts to strengthen facility-based primary care services need to go beyond simply focusing on improving infrastructure or quality of clinical care. There is a need to rethink how PHCs can be made more relevant to the health care needs of the communities they serve.

Fear of childbirth and depressive symptoms among postnatal women: A cross-sectional survey from Chhattisgarh, India

BACKGROUND

Prevalence rates of Fear of Birth and postnatal depressive symptoms have not been explored in Chhattisgarh, India.

OBJECTIVE

To validate Hindi Wijma Delivery Experience Questionnaire and to study the prevalence of Fear of Birth and depressive symptoms among postnatal women.

METHODS

A cross-sectional survey at seventeen public health facilities in two districts of Chhattisgarh, India among postnatal women who gave birth vaginally or through C-section to a live neonate. Participants were recruited through consecutive sampling based on health facility records of daily births. Data were collected through one-to-one interviews using the Wijma Delivery Experience Questionnaire Version B and the Edinburgh Postnatal Depression Scale. Non-parametric associations and linear regression data analyses were performed.

RESULTS

The Hindi Wijma Delivery Experience Questionnaire Version B had reliable psychometric properties. The prevalence of Fear of Birth and depressive symptoms among postnatal women were 13.1% and 17.1%, respectively, and their presence had a strong association (p<0.001). Regression analyses revealed that, among women having vaginal births: coming for institutional births due to health professionals' advice, giving birth in a district hospital and having postnatal depressive symptoms were associated with presence of FoB; while depressive symptoms were associated with having FoB, perineal suturing without pain relief, and giving birth to a low birth-weight neonate in a district hospital.

CONCLUSION

The prevalence of Fear of Birth and depressive symptoms is influenced by pain management during childbirth and care processes between women and providers. These care practices should be improved for better mental health outcomes among postnatal women.

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India

BACKGROUND

A woman's satisfaction with childbirth services can have a significant impact on her mental health and ability to bond with her neonate. Knowing postnatal women's opinions and satisfaction with services makes the services more women-friendly. Indian women's satisfaction with childbirth services has been explored qualitatively, or by using non-standard local questionnaires, but scientific data gathered with standardised questionnaires are extremely limited.

OBJECTIVE

To measure postnatal Indian women's satisfaction with childbirth services at selected public health facilities in Chhattisgarh, India.

METHODS

Cross-sectional survey using consecutive sampling (n = 1004) was conducted from March to May 2015. Hindi-translated and validated versions of the Scale for Measuring Maternal Satisfaction for Vaginal Births (VB) and Caesarean Births (CB) were used for data collection.

RESULTS

Although most of the women (VB 68.7%; CB 79.2%) were satisfied with the overall childbirth services received, those who had VB were least satisfied with the processes around meeting their neonates (mean subscale score 1.8, SD 1.3), while women having CB were least satisfied with postpartum care received (mean subscale score 2.7, SD 1.2). Regression analyses revealed that among women having VB, interacting with care providers, being able to maintain privacy, and being free from fear of childbirth had a positive influence on overall satisfaction with the childbirth. Among women having CB, earning their own salary and having a positive perception of self-health had associations with overall birth satisfaction.

CONCLUSIONS

Improving interpersonal interaction with nurse-midwives, and ensuring privacy during childbirth and hospital stay, are recommended first steps to improve women's childbirth satisfaction, until the supply gap is eliminated.

Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India

AIM

this study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities.

DESIGN

qualitative in-depth interviews were conducted and analysed using the Grounded Theory approach.

PARTICIPANTS

thirteen women who had given vaginal birth to a healthy newborn infant.

SETTING

participants were interviewed in their homes in one district of Chhattisgarh, India.

DATA COLLECTION

the interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth?

FINDINGS

'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers.

CONCLUSIONS

increasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.