Distance to available services for newborns at facilities in Malawi: A secondary analysis of survey and health facility data

Kimberly Peven,Debra Bick,Edward Purssell,Christabel Kambala,Cath Taylor,Kerry L M Wong,Lindsay Mallick,Louise T Day,Clara R Burgert-Brucker

doi:10.1371/journal.pone.0254083

Abstract

BackgroundMalawi has halved the neonatal mortality rate between 1990–2018, however, is not on track to achieve the Sustainable Development Goal 12 per 1,000 live births. Despite a high facility birth rate (91%), mother-newborn dyads may not remain in facilities long enough to receive recommended care and quality of care improvements are needed to reach global targets. Physical access and distance to health facilities remain barriers to quality postnatal care.MethodsUsing data We used individual data from the 2015–16 Malawi Demographic and Health Survey and facility data from the 2013–14 Malawi Service Provision Assessment, linking households to all health facilities within specified distances and travel times. We calculated service readiness scores for facilities to measure their capacity to provide birth/newborn care services. We fitted multi-level regression models to evaluate the association between the service readiness and appropriate newborn care (receiving at least five of six interventions).ResultsHouseholds with recent births (n = 6010) linked to a median of two birth facilities within 5–10 km and one facility within a two-hour walk. The maximum service environment scores for linked facilities median was 77.5 for facilities within 5–10 km and 75.5 for facilities within a two-hour walk. While linking to one or more facilities within 5-10km or a two-hour walk was not associated with appropriate newborn care, higher levels of service readiness in nearby facilities was associated with an increased risk of appropriate newborn care.ConclusionsWomen’s choice of nearby facilities and quality facilities is limited. High quality newborn care is sub-optimal despite high coverage of facility birth and some newborn care interventions. While we did not find proximity to more facilities was associated with increased risk of appropriate care, high levels of service readiness was, showing facility birth and improved access to well-prepared facilities are important for improving newborn care.

Highlights

Malawi more than halved its neonatal mortality rate between 1990 and 2019, from 50 to 20 deaths per 1,000 live births [1] and substantially increased the facility birth rate from 55% in 1992 to 91% in 2015–6 [2]
While we did not find proximity to more facilities was associated with increased risk of appropriate care, high levels of service readiness was, showing facility birth and improved access to well-prepared facilities are important for improving newborn care
Service readiness is a prerequisite for quality of care; it describes a health facility’s capacity to provide health services and requires components such as basic amenities, basic equipment, and essential medicines

Summary

Introduction

Malawi more than halved its neonatal mortality rate between 1990 and 2019, from 50 to 20 deaths per 1,000 live births [1] and substantially increased the facility birth rate from 55% in 1992 to 91% in 2015–6 [2]. Given high coverage of facility births, further investigation is needed to understand the quality of care at the time of birth and immediate postpartum period. Despite a high facility birth rate (91%), mother-newborn dyads may not remain in facilities long enough to receive recommended care and quality of care improvements are needed to reach global targets. Physical access and distance to health facilities remain barriers to quality postnatal care

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