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

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. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Blanc, Ann K. [verfasserIn] Diaz, Claudia McCarthy, Katharine J. Berdichevsky, Karla

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2016

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

Anmerkung:	© The Author(s). 2016

Übergeordnetes Werk:	Enthalten in: BMC pregnancy and childbirth - London : BioMed Central, 2001, 16(2016), 1 vom: 30. Aug.
Übergeordnetes Werk:	volume:16 ; year:2016 ; number:1 ; day:30 ; month:08

Links:	Volltext

DOI / URN:	10.1186/s12884-016-1047-0

Katalog-ID:	SPR027580806

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520			\|a 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.
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700	1		\|a Berdichevsky, Karla \|4 aut
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allfields	10.1186/s12884-016-1047-0 doi (DE-627)SPR027580806 (SPR)s12884-016-1047-0-e DE-627 ger DE-627 rakwb eng Blanc, Ann K. verfasserin aut Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 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. Maternal and newborn health (dpeaa)DE-He213 Quality of care (dpeaa)DE-He213 Intervention coverage (dpeaa)DE-He213 Validation (dpeaa)DE-He213 Measurement (dpeaa)DE-He213 Indicators (dpeaa)DE-He213 Skilled birth attendance (dpeaa)DE-He213 Diaz, Claudia aut McCarthy, Katharine J. aut Berdichevsky, Karla aut Enthalten in BMC pregnancy and childbirth London : BioMed Central, 2001 16(2016), 1 vom: 30. Aug. (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:16 year:2016 number:1 day:30 month:08 https://dx.doi.org/10.1186/s12884-016-1047-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 30 08
spelling	10.1186/s12884-016-1047-0 doi (DE-627)SPR027580806 (SPR)s12884-016-1047-0-e DE-627 ger DE-627 rakwb eng Blanc, Ann K. verfasserin aut Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 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. Maternal and newborn health (dpeaa)DE-He213 Quality of care (dpeaa)DE-He213 Intervention coverage (dpeaa)DE-He213 Validation (dpeaa)DE-He213 Measurement (dpeaa)DE-He213 Indicators (dpeaa)DE-He213 Skilled birth attendance (dpeaa)DE-He213 Diaz, Claudia aut McCarthy, Katharine J. aut Berdichevsky, Karla aut Enthalten in BMC pregnancy and childbirth London : BioMed Central, 2001 16(2016), 1 vom: 30. Aug. (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:16 year:2016 number:1 day:30 month:08 https://dx.doi.org/10.1186/s12884-016-1047-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 30 08
allfields_unstemmed	10.1186/s12884-016-1047-0 doi (DE-627)SPR027580806 (SPR)s12884-016-1047-0-e DE-627 ger DE-627 rakwb eng Blanc, Ann K. verfasserin aut Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 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. Maternal and newborn health (dpeaa)DE-He213 Quality of care (dpeaa)DE-He213 Intervention coverage (dpeaa)DE-He213 Validation (dpeaa)DE-He213 Measurement (dpeaa)DE-He213 Indicators (dpeaa)DE-He213 Skilled birth attendance (dpeaa)DE-He213 Diaz, Claudia aut McCarthy, Katharine J. aut Berdichevsky, Karla aut Enthalten in BMC pregnancy and childbirth London : BioMed Central, 2001 16(2016), 1 vom: 30. Aug. (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:16 year:2016 number:1 day:30 month:08 https://dx.doi.org/10.1186/s12884-016-1047-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 30 08
allfieldsGer	10.1186/s12884-016-1047-0 doi (DE-627)SPR027580806 (SPR)s12884-016-1047-0-e DE-627 ger DE-627 rakwb eng Blanc, Ann K. verfasserin aut Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 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. Maternal and newborn health (dpeaa)DE-He213 Quality of care (dpeaa)DE-He213 Intervention coverage (dpeaa)DE-He213 Validation (dpeaa)DE-He213 Measurement (dpeaa)DE-He213 Indicators (dpeaa)DE-He213 Skilled birth attendance (dpeaa)DE-He213 Diaz, Claudia aut McCarthy, Katharine J. aut Berdichevsky, Karla aut Enthalten in BMC pregnancy and childbirth London : BioMed Central, 2001 16(2016), 1 vom: 30. Aug. (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:16 year:2016 number:1 day:30 month:08 https://dx.doi.org/10.1186/s12884-016-1047-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 30 08
allfieldsSound	10.1186/s12884-016-1047-0 doi (DE-627)SPR027580806 (SPR)s12884-016-1047-0-e DE-627 ger DE-627 rakwb eng Blanc, Ann K. verfasserin aut Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 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. Maternal and newborn health (dpeaa)DE-He213 Quality of care (dpeaa)DE-He213 Intervention coverage (dpeaa)DE-He213 Validation (dpeaa)DE-He213 Measurement (dpeaa)DE-He213 Indicators (dpeaa)DE-He213 Skilled birth attendance (dpeaa)DE-He213 Diaz, Claudia aut McCarthy, Katharine J. aut Berdichevsky, Karla aut Enthalten in BMC pregnancy and childbirth London : BioMed Central, 2001 16(2016), 1 vom: 30. Aug. (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:16 year:2016 number:1 day:30 month:08 https://dx.doi.org/10.1186/s12884-016-1047-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 30 08
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topic_title	Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care Maternal and newborn health (dpeaa)DE-He213 Quality of care (dpeaa)DE-He213 Intervention coverage (dpeaa)DE-He213 Validation (dpeaa)DE-He213 Measurement (dpeaa)DE-He213 Indicators (dpeaa)DE-He213 Skilled birth attendance (dpeaa)DE-He213
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title	Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care
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title_full	Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care
author_sort	Blanc, Ann K.
journal	BMC pregnancy and childbirth
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author_browse	Blanc, Ann K. Diaz, Claudia McCarthy, Katharine J. Berdichevsky, Karla
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author-letter	Blanc, Ann K.
doi_str_mv	10.1186/s12884-016-1047-0
title_sort	measuring progress in maternal and newborn health care in mexico: validating indicators of health system contact and quality of care
title_auth	Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care
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. © The Author(s). 2016
abstractGer	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. © The Author(s). 2016
abstract_unstemmed	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. © The Author(s). 2016
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title_short	Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care
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