Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis.

Patrick Opiyo Owili,Bomar Rojas Mendez,Miriam Adoyo Muga,Bradley Chen,Cheryl A. Moyer

doi:10.1371/journal.pone.0177756

Patrick Opiyo Owili, Bomar Rojas Mendez + Show 3 more

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https://doi.org/10.1371/journal.pone.0177756

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Abstract

BackgroundImproving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in low- and middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care.MethodsThe 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15–49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique.ResultsThe negative binomial regression results identified a number of determinants of quality, such as the level of health facilities, managing authority, presence of delivery fee, central electricity supply and clinical guideline for maternal and neonatal care. Our structural equation modeling (SEM) further demonstrated that facility characteristics were important determinants of quality for initial assessment and postpartum care, while characteristics at the provider level became more important in shaping the quality of intrapartum care. Furthermore we also noted that quality of initial assessment had a positive association with quality of intrapartum care (β = 0.71, p < 0.001), which in turn was positively associated with the quality of newborn and immediate postpartum care (β = 1.29, p = 0.004).ConclusionsA continued focus on quality of care along the continuum of maternity care is important not only to mothers but also their newborns. Policymakers should therefore ensure that required resources, as well as adequate supervision and emphasis on the quality of obstetric care, are available.

Highlights

Maternal survival has been one of the most important developments and global health priorities in the past decades, exemplified by its adoption as the fifth Millennium Development Goals (MDG) [1,2] and subsequently the third Sustainable Development Goals (SDG) [3]
Our structural equation modeling (SEM) further demonstrated that facility characteristics were important determinants of quality for initial assessment and postpartum care, while characteristics at the provider level became more important in shaping the quality of intrapartum care
We noted that quality of initial assessment had a positive association with quality of intrapartum care (β = 0.71, p < 0.001), which in turn was positively associated with the quality of newborn and immediate postpartum care (β = 1.29, p = 0.004)

Summary

Background

Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and concerns for quality of maternal and newborn care in lowand middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care

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Results

Conclusions

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