Gap between contact and content in maternal and newborn care: An analysis of data from 20 countries in sub–Saharan Africa

Abstract

BackgroundOver the last decade, coverage of maternal and newborn health indicators used for global monitoring and reporting have increased substantially but reductions in maternal and neonatal mortality have remained slow. This has led to an increased recognition and concern that these standard globally agreed upon measures of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) only capture the level of contacts with the health system and provide little indication of actual content of services received by mothers and their newborns. Over this period, large household surveys have captured measures of maternal and newborn care mainly through questions assessing contacts during the antenatal, delivery and postnatal periods along with some measures of content of care. This study aims to describe the gap between contact and content –as a proxy for quality– of maternal and newborn health services by assessing level of co–coverage of ANC and PNC interventions.MethodsWe used Demographic and Health Surveys (DHS) data from 20 countries between 2010 and 2015. We analysed the proportion of women with at least 1 and 4+ antenatal care visit, who received 8 interventions. We also assessed the percentage of newborns delivered with a skilled birth attendant who received 7 interventions. We ran random effect logistic regression to assess factors associated with receiving all interventions during the antenatal and postnatal period.ResultsWhile on average 51% of women in the analysis received four ANC visits with at least one visit from a skilled health provider, only 5% of them received all 8 ANC interventions. Similarly, during the postnatal period though two–thirds (65%) of births were attended by a skilled birth attendant, only 3% of newborns received all 7 PNC interventions. The odds of receiving all ANC and PNC interventions were higher for women with higher education and higher wealth status.ConclusionThe gap between coverage and content as a proxy of quality of antenatal and postnatal care is excessively large in all countries. In order to accelerate maternal and newborn survival and achieve Sustainable Development Goals, increased efforts are needed to improve both the coverage and quality of maternal and newborn health interventions.

Service Quality beyond Access: A Multilevel Analysis of Neonatal, Infant, and Under-Five Child Mortality Using the Indian Demographic and Health Survey 2015~2016

“…37) Our findings provide useful insights to current literature and policy discussions around discrepancy between individual access to care and overall quality of care. [38][39][40] Lack of, or inadequate, ANC visits to a health facility as well as delivery without SBA or in non-institutional settings have been linked to increased risk of neonatal and infant mortality across LMICs. 8,[41][42][43] Other studies, however, have found non-significant relationships 12,14,41) and…”

“…questioned the underlying causal mechanisms as large gaps exist between contact and content of care during antenatal, birth and postnatal periods. 39,40) We attempted to further advance this literature by simultaneously assessing the relative importance of individual access to care and contextual provider quality in respect to neonatal, infant, and under-five mortality. In doing so, we found both to be importantly related to mortality outcomes, independent of one another, with the magnitude of associations being stronger for contextual provider quality.…”

Assessment of the Quality of Prenatal Consultations in the Regions of Kandi-Gogounou-Segbana in the Northern Benin

“…This echoes the results of a multicenter study [9] that included 7 countries where for almost 14,000 clinical consultations, the quality of care for pregnant women was relatively low: providers performed only half or two-thirds of a minimum set of recommended clinical actions. The chances of receiving all prenatal care interventions increased significantly with higher levels of education and wealth status [4]. The pregnant women of our study were dominated by housewives (65.5%).…”

“…Several unsatisfactory steps (Reception of pregnant, physical examination, tasks after examination, counseling/ advices) was insufficiently executed. This observation, although noted in Africa, varies from one country to another [4]. In Ethiopia [7], out of 823 pregnant women who received antenatal care, only one-third received prenatal care services of acceptable quality.…”

“…According to the 2011-2012 Demographic Health Survey conducted in Benin [3], 86% of pregnant women undergone prenatal consultations performed by trained staff in 86% of the cases. At the same time, maternal and neonatal mortality didn't decreased [4]. Our study therefore proposed to evaluate the quality of the RPNC of the KGS health zone.…”