Abstract
BackgroundImproving the quality of facility-based births is a critical strategy for reducing the high burden of maternal and neonatal mortality and morbidity across all settings. Accurate data on childbirth care is essential for monitoring progress. In northeastern Nigeria, we assessed the validity of childbirth care indicators in a rural primary health care context, as documented by health workers and reported by women at different recall periods.MethodsWe compared birth observations (gold standard) to: (i) facility exit interviews with observed women; (ii) household follow-up interviews 9-22 months after childbirth; and (iii) health worker documentation in the maternity register. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. We calculated the inflation factor (IF) to determine population-level validity.ResultsTwenty-five childbirth care indicators were assessed to validate health worker documentation and women’s self-reports. During exit interviews, women’s recall had high validity (AUC≥0.70 and 0.75<IF<1.25) for 9 of 20 indicators assessed; six additional indicators met either AUC or IF criteria for validity. During follow-up interviews, women’s recall had high validity for one of 15 indicators assessed, placing the newborn skin-to-skin; two additional indicators met IF criteria only. Health worker documentation had high validity for four of 10 indicators assessed; three additional indicators met AUC or IF criteria.ConclusionsIn addition to standard household surveys, monitoring of facility-based childbirth care should consider drawing from and linking multiple data sources, including routine health facility data and exit interviews with recently delivered women.
Highlights
Improving the quality of facility-based births is a critical strategy for reducing the high burden of maternal and neonatal mortality and morbidity across all settings
In northeastern Nigeria, we assessed the validity of childbirth care indicators in a rural primary health care context, as documented by health workers and reported by women at different recall periods
During follow-up interviews, women’s recall had high validity for one of 15 indicators assessed, placing the newborn skinto-skin; two additional indicators met inflation factor (IF) criteria only
Summary
We compared birth observations (gold standard) to: (i) facility exit interviews with observed women; (ii) household follow-up interviews 9-22 months after childbirth; and (iii) health worker documentation in the maternity register. Specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. We calculated the inflation factor (IF) to determine population-level validity. Study approvals were obtained from the London School of Hygiene & Tropical Medicine (reference 14091) and the Health Research Ethics Committees for Nigeria (reference NHREC/01/01/2007) and Gombe State (reference ADM/S/658/Vol II/66). Gombe is predominantly rural and 44% of the population have some primary school education. Most women access maternity care through public facilities. Seventy-two percent of women reported at least one antenatal care visit during their last pregnancy and 29% gave birth in a health facility [15]. In 2018, over 70% of facility deliveries took place in rural primary health facilities [32]
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