Abstract
IntroductionDespite 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.MethodsA 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.ResultsA 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).ConclusionQuality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.
Highlights
Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries
Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum
Once included in the study, a woman and thereafter her newborn were observed through the subsequent pause points (II and III) unless they were referred to another health facility or transferred to a different service
Summary
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. In-facility morbidity and mortality outcomes depend heavily on the quality of health care received by service users, as it conditions the effective delivery of interventions that meet their health needs [10]. Previous studies in sub-Saharan Africa (SSA) have reported that women’s future decisions on whether to use health facilities for delivery depend on their previous use experience [11, 12] Those not satisfied with the services received were less likely to sustain their service utilization [13]. The use of empirically validated indicators is rather infrequent but would improve quality measurement by providing a set of comprehensive indicators and solve issues related to the proliferation and inherent measurement errors of indicators [29]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
