Abstract
Considerable progress has been made in reducing maternal, newborn, and child mortality worldwide, but many more deaths could be prevented if effective interventions were available to all who could benefit from them. Timely, high-quality measurements of intervention coverage--the proportion of a population in need of a health intervention that actually receives it--are essential to support sound decisions about progress and investments in women's and children's health. The PLOS Medicine "Measuring Coverage in MNCH" Collection of research studies and reviews presents systematic assessments of the validity of health intervention coverage measurement based on household surveys, the primary method for estimating population-level intervention coverage in low- and middle-income countries. In this overview of the Collection, we discuss how and why some of the indicators now being used to track intervention coverage may not provide fully reliable coverage measurements, and how a better understanding of the systematic and random error inherent in these coverage indicators can help in their interpretation and use. We draw together strategies proposed across the Collection for improving coverage measurement, and recommend continued support for high-quality household surveys at national and sub-national levels, supplemented by surveys with lighter tools that can be implemented every 1-2 years and by complementary health-facility-based assessments of service quality. Finally, we stress the importance of learning more about coverage measurement to strengthen the foundation for assessing and improving the progress of maternal, newborn, and child health programs.
Highlights
Despite dramatic declines in child mortality over the past decade, in 2011 there were about 7 million deaths among children less than five years of age [1]
Effective interventions are available to prevent most of these deaths [3], but are not reaching all those who need them
Monitoring of coverage levels for maternal, newborn, and child health (MNCH) interventions is central to assessing progress toward national and international health goals
Summary
Despite dramatic declines in child mortality over the past decade, in 2011 there were about 7 million deaths among children less than five years of age [1]. The independent Expert Review Group’s 2012 report found that only 11 of the 75 countries that together account for over 95% of deaths among women and children had recent data on all eight coverage indicators recommended for global monitoring [6] This finding reflects experience gained in tracking progress toward the Millennium Development Goals [7], and points to the challenges that must be overcome to improve the use of information for action. The findings of the studies must be generalized with caution, because the sensitivity and specificity of the indicators may vary by characteristics of the host and the pathogen, the broader epidemiological setting (e.g., low levels of falciparum malaria in Bangladesh and Pakistan), and cultural and educational differences in interpreting and responding to survey questions Another set of challenges is more structural, and relates to the difficulty of measuring coverage using respondents’ reports for interventions that address relatively rare events. Measles vaccine Correct treatment of pneumonia (using DHS algorithms on symptoms of acute respiratory infection and detailed enquiry)
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