TY - JOUR
T1 - Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi
AU - Carvajal-Aguirre, Liliana
AU - Mehra, Vrinda
AU - Amouzou, Agbessi
AU - Khan, Shane M.
AU - Vaz, Lara
AU - Guenther, Tanya
AU - Kalino, Maggie
AU - Zaka, Nabila
N1 - Funding Information:
The Malawi MDG Endline Survey (MES) was carried out in 2013–14 by Malawi National Statistical Office as part of the global Multiple Indicator Cluster Survey (MICS) programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). The sample for the MES 2014 was designed to provide estimates for a large number of indicators at the national level; for urban and rural areas; the three regions (Northern Region, Central Region and Southern Region); and the 27 districts of Malawi excluding the island of Likoma due to logistical challenges. The sample was stratified by district with the aim of obtaining representative estimates at each district level. Within each district, the sample was further stratified by urban–rural, before a two stage cluster sampling was implemented. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size [21]. All the information obtained from respondents remains strictly confidential and anonymous. Although GPS coordinates of each sample cluster was collected, this information was not collected of respondents’ household.
Funding Information:
The Malawi Service Provision Assessment MSPA 2014 was implemented by the Malawi Ministry of Health. ICF International provided technical assistance through the MEASURE DHS program, which is funded by USAID and is designed to assist countries in collecting data to monitor and evaluate population, health, and nutrition programmes [22]. The MSPA 2014 is considered a census of facilities in the country as it covers all of Malawi’s health facilities including public and semi–public facilities of all levels, CHAM as well as major private facilities [22]. The survey assesses whether components considered essential for quality service delivery are present and functioning [22]. Data also includes precise location using GPS of all facilities in the country.
PY - 2017/12/20
Y1 - 2017/12/20
N2 - Background Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. Methods We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Results Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, P = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, P < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. Conclusions There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of health staff in facilities that offer normal delivery and newborn care services at all levels in the country.
AB - Background Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. Methods We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Results Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, P = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, P < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. Conclusions There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of health staff in facilities that offer normal delivery and newborn care services at all levels in the country.
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U2 - 10.7189/jogh.07.020508
DO - 10.7189/jogh.07.020508
M3 - Article
C2 - 29423185
AN - SCOPUS:85039069614
SN - 2047-2978
VL - 7
JO - Journal of global health
JF - Journal of global health
IS - 2
M1 - 020508
ER -