Quality Of Child Health Care Research Articles

The moderating effects of nurses’ characteristics on the perceptions and practices of family-centered care for chronically ill children and their families in Saudi Arabia

Background/purposeNurses play a vital role in providing effective family-centered care (FCC) to enhance the quality of healthcare for children with chronic illnesses and increase family satisfaction. This study aimed to investigate nurses' perceptions and practices of FCC for children with chronic illnesses, and how nursing characteristics influence this relationship.MethodThis multicenter cross-sectional study involved a convenience sample of 405 nurses, each with at least six months of experience caring for chronically ill children, infants, and toddlers in Saudi Arabia. An online survey was conducted between February 2023 and August 2023. A paired sample t-test of differences between nurses’ perceptions and practices of FCC among chronically ill children was performed. Correlations were carried out to test the relationships between nurses’ perceptions and practices of FCC and their sociodemographic factors, including age, gender, marital status, education level, and years of work experience, and attributes of nurses, including professional competence, interpersonal skills, job commitment, and knowing one’s self. Moderation analyses were conducted using the SPSS PROCESS macro version 4.ResultsNurses’ FCC practice was significantly poorer than their perception. The moderation analysis highlighted that marital status (β = 0.122, p = .014), interpersonal skills (β = 0.131, p = .002), job commitment (β = 0.096, p = .024), and self-awareness (β = 0.127, p < .001) significantly strengthened the relationship between FCC perception and practice.ConclusionsNurses’ sociodemographic factors and personal attributes influenced the relationship between their perceptions of FCC and its implementation. Leaders should consider aspects such as marital status, interpersonal skills, job commitment, and self-awareness as these factors affect the strength of this relationship. Further research is needed to assess these impacts through longitudinal design and causal intervention studies to create a conceptual model of FCC for children with chronic illnesses.

Understanding Caretakers' Treatment Facility Preferences for Children with Febrile Illnesses: Insights from Ishaka Town, Bushenyi District, Uganda

This study was carried out to assess the factors that influence choice of treatment facility by the caretakers of children with febrile illnesses in Ishaka town, Bushenyi district. A total of 50 questionnaires were issued to respondents after attaining their consent. The respondents were chosen randomly. The study showed that transport costs, good customer care and quality of health care were the major factors that influenced the choice of treatment facility for children in Ishaka town. The biggest number of caretakers is the mothers of these children, who are mostly housewives. These caretakers usually seek treatment from private providers near them, such as clinics and drug shops. Caretakers prefer treatment facilities with a constant supply of drugs, knowledge of health care provider, and diagnostic services as they have a perception that quality of care provided depends on these factors. To increase access of quality health care for children with febrile illness, all aspects need to be addressed. Health care providers need to be accessible and avail the community with appropriate medication. The community need to be sensitized on the signs and symptoms commonly affecting children with febrile illnesses, as well as training the drug shop owners on how to diagnose diseases based on the symptoms manifested. Keywords: Febrile illnesses, Treatment, facility, Caretakers, Healthcare.

What is known about Australian child protection practitioners’ participation in the health care of children living in out of home care: a scoping review

PurposeThere is a growing recognition of the urgency to enhance health outcomes for children and young people residing in out-of-home care (OOHC). Research underscores the need to establish effective pathways to quality health care for children and young people who have been exposed to trauma. Child protection (CP) practitioners should play a vital role in proactively improving health outcomes and navigating the intricacies of healthcare systems. Their involvement in initiating and collaborating on healthcare interventions is pivotal for the well-being of these vulnerable children and young people. However, challenges associated with poor health literacy and the complexities of healthcare systems hinder collaborative service delivery in the Australian context. This review explores how CP practitioners support the health care of children and young people in their care.Design/methodology/approachA scoping review followed Arksey and O’Malley’s framework, employing a narrative synthesis to assess the selected studies.FindingsHealth outcomes for children and young people in OOHC remain under-researched and potentially under-resourced within the realm of CP practice. There is room for enhanced practices and system integration in CP service delivery to better address health needs and prevent further health and well-being disparities.Originality/valueThrough this scoping review and involving industry experts in the discussion of findings, this study contributes valuable insights to the existing knowledge base regarding the active participation of CP practitioners in addressing the healthcare needs of vulnerable children.

Prenatal Care Initiation and Exposure to Teratogenic Medications

With new legal abortion restrictions, timing of prenatal care initiation is critical to allow for discussion of reproductive options among pregnancies exposed to teratogenic medications. To investigate the prevalence of prenatal exposure to teratogenic medications and prenatal care initiation across gestational weeks. This descriptive, population-based cross-sectional study used health encounter data from a national sample of individuals with employer-sponsored health insurance. A validated algorithm identified pregnancies among persons identifying as female that ended with a live or nonlive outcome between January 2017 and December 2019. Data were analyzed from December 2022 to December 2023. Prenatal exposure to any of 137 teratogenic medications, measured via pharmacy and medical claims. Measurement of prenatal care initiation was adapted from the Children's Health Care Quality Measures. Prevalence of prenatal exposure to teratogens and prenatal care initiation by gestational week. Timing of prenatal teratogenic exposure was compared with timing of prenatal care initiation and legal abortion cutoffs. Among 639 994 pregnancies, 472 472 (73.8%; 95% CI, 73.7%-73.9%) had a live delivery (mean [SD] age, 30.9 [5.4] years) and 167 522 (26.2%; 95% CI, 26.1%-26.3%) had a nonlive outcome (mean [SD] age, 31.6 [6.4] years). Of pregnancies with live deliveries, 5.8% (95% CI, 5.7%-5.8%) were exposed to teratogenic medications compared with 3.1% (95% CI, 3.0%-3.2%) with nonlive outcomes. Median time to prenatal care was 56 days (IQR, 44-70 days). By 6 weeks' gestation, 8186 pregnancies had been exposed to teratogenic medications (25.2% [95% CI, 24.7%-25.7%] of pregnancies exposed at any time during gestation; 1.3% [95% CI, 1.3%-1.3%] of all pregnancies); in 6877 (84.0%; 95% CI, 83.2%-84.8%), prenatal care was initiated after 6 weeks or not at all. By 15 weeks, teratogenic exposures had occurred for 48.9% (95% CI, 48.4%-49.5%) of all teratogen-exposed pregnancies (2.5% [2.4-2.5] of all pregnancies); prenatal care initiation occurred after 15 weeks for 1810 (16.8%; 95% CI, 16.1%-17.5%) with live deliveries and 2975 (58.3%; 95% CI, 56.9%-59.6%) with nonlive outcomes. Teratogenic medications most used within the first 15 gestational weeks among live deliveries included antiinfectives (eg, fluconazole), anticonvulsants (eg, valproate), antihypertensives (eg, lisinopril), and immunomodulators (eg, mycophenolate). For nonlive deliveries, most antihypertensives were replaced by vitamin A derivatives. In this cross-sectional study, most exposures to teratogenic medications occurred in early pregnancy and before prenatal care initiation, precluding prenatal risk-benefit assessments. Prenatal care commonly occurred after strict legal abortion cutoffs, prohibiting consideration of pregnancy termination if concerns about teratogenic effects arose.

Trends in the quality of child health care in the first week of life in primary care services in Brazil.

The aim of this study was to assess temporal trends in the quality of health care during the first-week child check-up in primary care services stratified by municipal, health team and maternal characteristics. We conducted a cross-sectional study using data from the three cycles of the National Program for the Improvement of Access and Quality (PMAQ) (2012, 2014 and 2018). Adult service users with children aged up to 2 were interviewed. The outcome was "good quality health care in the first week of life". Descriptive and time trend analyses were performed using variance-weighted least squares regression. The frequency of good quality care during the first-week check-up was 47.9% (95%CI 46.6-49.3) in 2012, 52.5% (95%CI 51.3-53.7) in 2014 and 53.3% (95%CI 52.2-54.4) in 2018, with an annual increase of 0.73 pp (p<0.001). The annual increase was greater in the Northeast (2.06 pp) and in municipalities with very low/low HDI (1.48 pp) and 100% family health strategy coverage (0.98 pp). Trends in the frequency of good quality health care during the first-week child check-up were favorable.

Child health nursing in the Solomon Islands: A qualitative evaluation of the impact of the 'Bachelor of nursing - Child health'.

To explore graduates' perceptions of the impact on nursing practice of a new postgraduate course in child health, developed and implemented in the Solomon Islands in 2016. The Bachelor of Nursing -Child Health was implemented in 2016 to develop nurses' knowledge and skills in child health and paediatric care with the intent to improve national child health outcomes. A qualitative exploratory, descriptive design was used to evaluate the impact of the Bachelor of Nursing -Child Health on graduates' nursing practice. Fourteen nurses who graduated from the first cohort of students enrolled in the child health course were purposively selected to participate. Participants engaged in individual semi-structured interviews, conducted between August and December 2018. A thematic analysis was undertaken following Braun and Clarke's six-phase process. Findings from the study demonstrate positive impacts of the course on graduates' nursing practice. These include a perceived enhanced quality of care through their commitment to evidence-based practice, the ability to contribute to capacity building of colleagues, the reinforcement of provincial public health programmes and expanded participation in managerial activities. Following graduation, most alumni took on senior roles and greater responsibilities, felt more confident in managing unwell children, felt there was better access to and quality of child health care at the community and broader country levels and felt recognised by colleagues and communities. Some graduates faced resistance from colleagues to change practice and felt that despite being given greater responsibilities, nursing levels and salaries remained unchanged. This reflected a potential lack of recognition from hospital or provincial managers, the Nursing Council as the regulatory body for the nursing profession, and the Ministry of Health and Medical Services. A lack of human and material resources also impacted quality of care. Findings from this study underline the need for the Solomon Islands National University, the Nursing Council, the Public Service and the Ministry of Health and Medical Services to concord and delineate formal accreditation standards for child health nurses. Overall, collaborative efforts and commitments at local, regional and global levels are required to support child health nurses in their ability and ambition to improve national child health outcomes. Findings from this study demonstrate positive impacts of the course on graduates' nursing practice. The impact of increasing nurses' knowledge and skills on national child health outcomes could be significant. Ongoing implementation and recognition of this course in the Solomon Islands, as well as more broadly across the Pacific region, are recommended.

Immunization Information Systems.

Immunization (IZ) information systems (IISs) are confidential, computerized, population-based systems that collect and consolidate IZ data from vaccination providers. The American Academy of Pediatrics continues to support the development and implementation of IISs as a beneficial tool to provide quality health care for children. Since the last revision of the American Academy of Pediatrics policy statement on IISs in 2006, numerous public health events and new data demonstrate the importance and value of these systems in society and expand the functionality and benefits of IISs beyond the basic IZ database intended to improve childhood IZ rates. This policy statement update will describe additional functions and benefits of IISs, as well as persistent and novel challenges and barriers that these systems face and pose to practicing pediatricians. Pediatricians and other pediatric health care practitioners should be aware of the value of IISs to society, the incentives and barriers involved in incorporating IIS access into a medical practice, and the opportunities to improve IISs and their functionality and usability in daily pediatric practice.

The management of acute pancreatitis among children on chronic ambulatory peritoneal dialysis during COVID-19 pandemic crisis in Indonesia: report of two cases

Background: Children on dialysis seem to be at greater risk for COVID-19. Acute pancreatitis (AP) is an infrequent but severe complication of chronic peritoneal dialysis (PD). It contributes to morbidity and mortality rates of up to 25%. Patients with PD are exposed to a series of factors associated with AP risk. This report aimed to describe rare and interesting cases of acute pancreatitis in children with CAPD following PD-related peritonitis with a favorable response to conservative treatment. Case report: We present two cases admitted to our emergency room (ER) with severe abdominal pain preceded by PD-related peritonitis. Poor adherence, lack of monitoring, and healthcare service restriction during the COVID-19 pandemic predisposed these patients to PD-related complications. Patients were diagnosed as AP based on the revised Atlanta criteria. Both met the criteria as they had abdominal pain, a threefold increase of pancreatic enzymes, and evidence of pancreatitis through ultrasonography (USG) investigation. Both patients presented a rapid resolution of AP after receiving conservative treatment, including fasting, total parenteral nutrition (TPN), prophylactic antibiotics, and analgesics. None of them experienced invasive intervention due to AP. Conclusion: Diagnosing AP in children with CAPD may be challenging since the symptoms mimic other abdominal problems. Our cases are likely to be associated with PD-related peritonitis. This report may prove conservative treatment as a recommendation for managing AP in children with CAPD. The rapid development of innovative clinical management strategies in response to the COVID-19 pandemic is crucial to improving children's health care quality with CAPD.

Improved management of pediatric obesity in the primary care setting through implementation of the healthy care for healthy kids obesity toolkit

Pediatric obesity has become a major health care concern over the last several decades. This condition can lead to detrimental life-long physical and mental comorbidities. Pediatric primary care providers have a unique opportunity to both prevent and treat pediatric obesity in their clinics. However, discussing this topic with families can be uncomfortable and time consuming. Time efficient resources to educate and increase confidence are needed to improve the management of pediatric obesity. This quality improvement project integrated the Healthy Care for Healthy Kids by the National Institute for Children's Healthcare Quality (2014) into the electronic medical record at a pediatric primary care office in rural East Tennessee. This toolkit included handouts, management algorithms, and provider education for pediatric obesity. After an 8-week implementation period, improvements in lab draws and evaluation of a family’'s readiness to change were noted. Overall, providers reported the toolkit was helpful and improved patient interaction. Currently, the clinic is still utilizing the integrated resources and handouts.

PQMP Phase 2: Implementation and Dissemination.

In 2009, the Children's Health Insurance Program Reauthorization Act provided an opportunity to consider and enhance the measurement of children's health care quality as a means to improve child health.1 The legislation required the identification of an initial Child Core Set of pediatric quality measures for voluntary use by Medicaid/Child Health Insurance Programs. The initial child core set was published in 2009 and is updated annually with 2024 being the first year of mandatory reporting.2

Stakeholder Engagement: Bridging Research and Policy to Improve Measurement and Dental Care for Children in Medicaid.

Stakeholder Engagement: Bridging Research and Policy to Improve Measurement and Dental Care for Children in Medicaid.

Quality of care for children with acute respiratory infections in health facilities: a comparative analysis of assessment tools.

BackgroundSevere childhood pneumonia requires treatment in hospital by trained health care workers. It is therefore important to determine if health facilities provide quality health services for children with acute respiratory infections (ARI), including pneumonia. Using established indicators from WHO to measure quality of care (QoC) as a reference standard, this review aims to evaluate how well existing tools assess QoC for children presenting to health facilities with ARI.MethodsExisting assessment tools identified from a published systematic literature review that evaluated QoC assessment tools for children (<15 years) in health facilities for all health conditions were included in this ARI-specific review. 27 ARI-specific indicators or “quality measures” from the WHO “Standards for improving quality of care for children and young adolescents in health facilities” were selected for use as a reference standard to assess QoC for children presenting to health facilities with ARI symptoms. Each included assessment tool was evaluated independently by two paediatricians to determine how many of the WHO ARI quality measures were assessable by the tool. The assessment tools were then ranked in order of percentage of ARI quality measures assessable.ResultsNine assessment tools that assessed QoC for children attending health facilities were included. Two hospital care tools developed by WHO had the most consistency with ARI-specific indicators, assessing 22/27 (81.5%) and 20/27 (74.1%) of the quality measures. The remaining tools were less consistent with the ARI-specific indicators, including between zero to 16 of the 27 quality measures. The most common indicators absent from the tools were assessment of appropriate use of pulse oximetry and administration of oxygen, how often oxygen supply was unavailable, and mortality rates.ConclusionsThe existing WHO hospital-based QoC assessment tools are comprehensive but could be enhanced by improved data quality around oxygen availability and appropriate use of pulse oximetry and oxygen administration. Any tools, however, should be considered within broader assessments of QoC, rather than utilised in isolation. Further adaptation to local settings will improve feasibility and facilitate progress in the delivery of quality health care for children with ARI.RegistrationThe protocol of the original systematic review was registered in PROSPERO ID: CRD42020175652.

Expressions of actor power in implementation: a qualitative case study of a health service intervention in South Africa

BackgroundImplementation frameworks and theories acknowledge the role of power as a factor in the adoption (or not) of interventions in health services. Despite this recognition, there is a paucity of evidence on how interventions at the front line of health systems confront or shape existing power relations. This paper reports on a study of actor power in the implementation of an intervention to improve maternal, neonatal and child health care quality and outcomes in a rural district of South Africa.MethodsA retrospective qualitative case study based on interviews with 34 actors in three ‘implementation units’ – a district hospital and surrounding primary health care services – of the district, selected as purposefully representing full, moderate and low implementation of the intervention, some three years after it was first introduced. Data are analysed using Veneklasen and Miller’s typology of the forms of power – namely ‘power over’, ‘power to’, ‘power within’ and ‘power with’.ResultsMultiple expressions of actor power were evident during implementation and played a plausible role in shaping variable implementation, while the intervention itself acted to change power relations. As expected, a degree of buy-in of managers (with power over) in implementation units was necessary for the intervention to proceed. Beyond this, the ability to mobilise collective action (power with), combined with support from champions with agency (power within) were key to successful implementation. However, local empowerment may pose a threat to hierarchical power (power over) at higher levels (district and provincial) of the system, potentially affecting sustainability.ConclusionsA systematic approach to the analysis of power in implementation research may provide insights into the fate of interventions. Intervention designs need to consider how they shape power relations, especially where interventions seek to widen participation and responsiveness in local health systems.

Quality of child healthcare in European countries: common measures across international databases and national agencies.

BackgroundThe evaluation of child healthcare is not yet widely explored, especially from a cross-country comparison perspective. The routine adoption of measures by national assessment agencies is under-investigated. Though the guiding principles developed at international level call for a child-centric multi-dimensional evaluation of child care, its feasibility is hampered by the availability of robust and harmonized data.MethodsTo explore the data availability, international databases (IDBs) were scrutinized and measures dealing with child health-related issues were collated. In parallel, an ad hoc questionnaire was administrated to 30 Country Agents (CAs) to gather measures routinely adopted at local level. To facilitate the comparison of measures, a three-level conceptual map was developed.ResultsThe IDBs yielded at 207 measures that pertained mainly to non-health determinants of health, whereas the 352 measures obtained from CAs focused on process and outcome. A set of 33 common measures that related to immunization, morbidity and mortality were identified.ConclusionsA limited set of measures used both in IDBs and at national level identify common areas of concerns that certainly capture crucial issues with child prevention and health outcomes. However, they are far from satisfying a child-centric multi-dimensional approach to the evaluation of child well-being and well-becoming. There is room for improvement at both international and national levels. IDBs should include and harmonize measures that concern the provision of child-centric services and encompass physical, social and mental development. At the national level, efforts towards the inclusion of measures that concern non-health determinants of health should be pursued.

Prevalence of Stillbirth and Associated Factors among Immediate Postpartum Mothers at Bahir Dar, Felegehiwot Hospital, Northwest Ethiopia: Cross-sectional Study

Background: Stillbirth rates are among the indicators of maternal and child health care quality in the countries. However, the majority of neonatal deaths and almost all stillbirths were underreported in Ethiopia. Therefore, this study aimed to determine the prevalence of stillbirth and associated factors among immediate postpartum mothers in the study area. Methods: An institution-based cross-sectional study was employed at Felegehiwot comprehensive specialized hospital from March to May 2016 (n=310). A pretested structured interviewer- administered questionnaire and medical chart reviews were used to collect data from immediate postpartum mothers. Data were entered into Epi Info version 7 and analyzed using SPSS version 20. The binary logistic regression model fitted to identify stillbirth; adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. Variables having less than 0.05 p-value of in the multivariable considered as factors associated with stillbirths. Result: The prevalence of stillbirth was 8.7% (95%CI: 5.8, 12.4). Rural dwelling (AOR=2.86, 95%CI: 1.10 7.47), twin pregnancy (AOR=6.69, 95% CI: 1.77, 25.2), medical or obstetrical illnesses during pregnancy (AOR=5.54, 95%CI: 1.71 17.94) and complications during labor and delivery (AOR=4.96, 95%CI: 1.48 16.58) were factors associated with stillbirths. Conclusion: This study revealed that the magnitude of stillbirth was high in rural dwelling, twin pregnancy, medical or obstetrical illnesses during pregnancy, and complicated labor were associated with increased occurrences of stillbirth. This finding suggests that particular emphasis on rural dwellers and strengthening quality of Maternal in pregnancy and labor delivery service and proper following during labor attending process are mandatory to reduce stillbirth.

Quality of healthcare for children with severe acute malnutrition in a refugee setting: cross-sectional study in West Nile Region, Uganda

Objectives5.0 million annual deaths in low-income and middle-income countries are due to poor quality of care (QOC). We evaluated the QOC provided to malnourished children in West Nile Region in...

Designing a Multistakeholder Collaboration to Improve Preventive Care for Children With Sickle Cell Anemia.

Newly developed measures of health care quality for children with sickle cell anemia (SCA) have revealed significant performance gaps in recommended care. Historically, health systems, Medicaid health plans, and state Medicaid programs have not partnered with patients and families to improve SCA care delivery. We organized 2 novel multistakeholder design meetings to identify potential interventions to deliver high-quality preventive care for children with SCA. Invitees included patients with SCA, families, and representatives from pediatric hematology clinics, Medicaid health plans, community organizations, and a state Medicaid program. Participants identified some barriers to care through presentations and facilitated discussions. Over 35 potential interventions and 6 drivers of high-quality SCA preventive care delivery were organized into a key driver diagram. Many barriers to SCA care delivery could be addressed by Medicaid health plan resources to support members with chronic disease; however, these resources are infrequently used in the pediatric SCA population. Bridging gaps between stakeholder groups identified many potential interventions to improve SCA preventive care delivery at all levels of the health care system. Similar multistakeholder discussions may be useful for other communities interested in improving preventive care for children with SCA or other chronic pediatric diseases.

Completeness of the Road-to-Health Booklet and Road-to-Health Card: Results of cross-sectional surveillance at a provincial tertiary hospital.

BackgroundAccurate record-keeping is important for continuity and quality of care. Completing a child’s Road-to-Health Booklet (RTHB), or the older, less detailed, Road-to-Health Card/Chart (RTHC), immediate interpretation thereof and appropriate action facilitates comprehensive care, which could contribute to a decline in child morbidity and mortality.ObjectiveThis study aimed to assess the extent to which healthcare personnel working in catchment clinics of Kalafong Provincial Tertiary Hospital (KPTH), Tshwane district, South Africa, complete HIV-related, sociodemographic, neonatal, growth and immunisation information in the RTHC and/or RTHB.MethodsA cross-sectional, quantitative record review was conducted. Data were extracted from 318 RTHCs and/or RTHBs of children attending KPTH for paediatric care. Data extraction focused on six main areas, namely documentation of HIV-related, neonatal, sociodemographic, anthropometric, immunisation and vitamin A-related information. During data analysis, age-appropriate completeness scores were generated for each area and completeness of documentation in the RTHB and RTHC was assessed.ResultsData demonstrate significantly less unrecorded HIV-related information (maternal HIV status, timing of maternal HIV testing, timing of maternal antiretroviral therapy [ART] initiation, current maternal ART use and infant feeding decisions) in RTHBs compared with RTHCs (p < 001). Despite this, 24% of all RTHBs had no record of maternal HIV status and 67% of RTHBs from documented HIV-exposed infants had no record of maternal ART duration. Neonatal information completeness was similar between RTHBs and RTHCs, but socio-demographic completeness was significantly better in RTHBs compared with RTHCs (p = 0.006). Growth (especially weight), immunisation and vitamin A completeness was > 80% and similar between RTHBs and RTHCs. Length-for-age, weight-for-length and head circumference were plotted in < 5% of RTHBs and none of the RTHCs.ConclusionAlthough completeness of key HIV-related information was better in RTHBs compared with RTHCs, RTHB completeness was suboptimal. Healthcare personnel need reminders to utilise the RTHB optimally to improve continuity and quality of child healthcare.

Identifying Critical Issues in the Perception of Caregivers about Quality of Child Health Care Services Using a Modified Delphi Technique

Background: Identification of the elements of the perception users of health services is a critical step in the development of measurement scales to assess such perception. This study is the second of a three phase approach to create a validated tool for the assessment of caregiver’s perceived quality of child health care in Primary health care (PHC) facilities. The first phase was exploratory using qualitative methods to assess the perceptions of caregivers about quality of child health care services; it yielded 39 quality-of-care items. Method: In this current study, we subjected the 39 quality of care items to expert review using the modified Delphi method. This method is useful for providing evidence for content validity in quantitative scale design. A total of 33 experts, including public health specialists, pediatricians and medical sociologists, participated in three iterative rounds. In each round the experts awarded score to the items and consensus amongst experts was determined by calculating inter quartile range of the assigned scores. Results: At the end of the three rounds of expert review, the total number of question items that had shown consensus considerably amongst the expert reviewers was 23. Conclusion: For these 23 items, a three point Likert scale response format was framed appropriately as a quantitative scale for assessing perceived quality of child health services in PHC facilities.

How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy?

BackgroundInfant mortality rates are commonly used to compare the health of populations. Observed differences are often attributed to variation in child health care quality. However, any differences are at least partly explained by variation in the prevalence of risk factors at birth, such as low birth weight. This distinction is important for designing interventions to reduce infant mortality. We suggest a simple method for decomposing inter-country differences in crude infant mortality rates into two metrics representing risk factors operating before and after birth.MethodsWe used data from 7 European countries participating in the EURO-PERISTAT project in 2010. We calculated crude and birth weight-standardised stillbirth and infant mortality rates using Norway as the standard population. We decomposed between-country differences in crude stillbirth and infant mortality rates into the within-country difference in crude and birth weight-standardised stillbirth and infant mortality rates (metric 1), reflecting prenatal risk factors, and the between-country difference in birth weight-standardised stillbirth and infant mortality rates (metric 2), reflecting risk factors operating after birth. We also calculated birth weight-specific mortality.ResultsUsing our metrics, we showed that for England, Wales and Scotland risk factors before and after birth contributed equally to the differences in crude stillbirth and infant mortality rates relative to Norway. In Austria, Czech Republic and Switzerland the differences were driven primarily by metric 1, reflecting high rate of low birth weight. The highest values of metric 2 observed in Poland partially reflected high rates of congenital anomalies.ConclusionsOur suggested metrics can be used to guide policy decisions on preventing infant deaths through reducing risk factors at birth or improving the care of babies after birth. Aggregate data tabulated by birth weight/gestational age should be routinely collected and published in high-income countries where birth weight is reported on birth certificates.