TY - JOUR
T1 - Measuring the quality of maternal and care processes at the time of delivery in sub-Saharan Africa
T2 - Development and validation of a short index
AU - Tripathi, Vandana
AU - Stanton, Cynthia
AU - Strobino, Donna
AU - Bartlett, Linda
N1 - Funding Information:
This study was supported by USAID (www.usaid.gov), through the MCHIP project (www.mchip.net), USAID Award #GHS-A-00-08-00002-000. Open access publication of this paper was supported through the USAID Associate Cooperative Agreement AID‐OAA‐A14‐00013. The funder had no role in study design, data collection and analysis, or decision to publish. Representatives of the funder were provided with a draft of this manuscript before submission for publication.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/4/16
Y1 - 2019/4/16
N2 - Background: There is a growing recognition that quality of care must improve in facility-based deliveries to achieve further global reductions in maternal and newborn mortality and morbidity. Better measurement of care quality is needed, but the unpredictable length of labor and delivery hinders the feasibility of observation, the gold standard in quality assessment. This study evaluated whether a measure restricted to actions at or immediately following delivery could provide a valid assessment of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC), including essential newborn care. Methods: The study used a comprehensive QoPIIPC index developed through a modified Delphi process and validated by delivery observation data as a starting point. A subset of items from this index assessed at or immediately following delivery was identified to create a "delivery-only" index. This delivery-only index was evaluated across content and criterion validation domains using delivery observation data from Kenya, Madagascar, and Tanzania, including Zanzibar. Results: The delivery-only index included 13 items and performed well on most validation criteria, including correct classification of poorly and well-performed deliveries. Relative to the comprehensive QoPIIPC index, the delivery-only index had reduced content validity, representing fewer dimensions of QoPIIPC. The delivery-only index was also less strongly associated with overall quality performance in observed deliveries than the comprehensive QoPIIPC index. Conclusions: Where supervision resources are limited, a measure of the quality of labor and delivery care targeting the time of delivery may mitigate challenges in observation-based assessment. The delivery-only index may enable increased use of observation-based quality assessment within maternal and newborn care programs in low-resource settings.
AB - Background: There is a growing recognition that quality of care must improve in facility-based deliveries to achieve further global reductions in maternal and newborn mortality and morbidity. Better measurement of care quality is needed, but the unpredictable length of labor and delivery hinders the feasibility of observation, the gold standard in quality assessment. This study evaluated whether a measure restricted to actions at or immediately following delivery could provide a valid assessment of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC), including essential newborn care. Methods: The study used a comprehensive QoPIIPC index developed through a modified Delphi process and validated by delivery observation data as a starting point. A subset of items from this index assessed at or immediately following delivery was identified to create a "delivery-only" index. This delivery-only index was evaluated across content and criterion validation domains using delivery observation data from Kenya, Madagascar, and Tanzania, including Zanzibar. Results: The delivery-only index included 13 items and performed well on most validation criteria, including correct classification of poorly and well-performed deliveries. Relative to the comprehensive QoPIIPC index, the delivery-only index had reduced content validity, representing fewer dimensions of QoPIIPC. The delivery-only index was also less strongly associated with overall quality performance in observed deliveries than the comprehensive QoPIIPC index. Conclusions: Where supervision resources are limited, a measure of the quality of labor and delivery care targeting the time of delivery may mitigate challenges in observation-based assessment. The delivery-only index may enable increased use of observation-based quality assessment within maternal and newborn care programs in low-resource settings.
KW - Labor and delivery care
KW - Measure development
KW - Newborn care
KW - Postpartum care
KW - Quality of care
KW - Sub-Saharan Africa
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U2 - 10.1186/s12884-019-2281-z
DO - 10.1186/s12884-019-2281-z
M3 - Article
C2 - 30991979
AN - SCOPUS:85064405062
VL - 19
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
SN - 1471-2393
IS - 1
M1 - 133
ER -