Measuring Coverage in MNCH: Testing the Validity of Women's Self-Report of Key Maternal and Newborn Health Interventions during the Peripartum Period in Mozambique

Abstract

BackgroundAs low-income countries strive to meet targets for Millennium Development Goals 4 and 5, there is growing need to track coverage and quality of high-impact peripartum interventions. At present, nationally representative household surveys conducted in low-income settings primarily measure contact with the health system, shedding little light on content or quality of care. The objective of this study is to validate the ability of women in Mozambique to report on facility-based care they and their newborns received during labor and one hour postpartum.Methods and FindingsThe study involved household interviews with women in Mozambique whose births were observed eight to ten months previously as part of a survey of the quality of maternal and newborn care at government health facilities. Of 487 women whose births were observed and who agreed to a follow-up interview, 304 were interviewed (62.4%). The validity of 34 indicators was tested using two measures: area under receiver operator characteristic curve (AUC) and inflation factor (IF); 27 indicators had sufficient numbers for robust analysis, of which four met acceptability criteria for both (AUC >0.6 and 0.75<IF<1.25). Two of these indicators are considered high demand and are recommended for incorporation into international survey programs: presence of a support person during labor/delivery and placement of the newborn skin to skin against the mother. Nine indicators met acceptability criteria for one of the validity measures. All 13 indicators are recommended for use in in-depth maternal/newborn health surveys.ConclusionsWomen are able to report on some aspects of peripartum care. Larger studies may be able to validate some indicators that this study could not assess due to the sample size. Future qualitative research may assist in improving question formulation for some indicators. Studies of similar design in other low-income settings are needed to confirm these results.

Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya

“…Of the four indicators that met both validation criteria in this study, a support person present during birth [3], and cesarean section [4,5] have also been found to be reported accurately by women in prior studies.…”

Does adjusting for recall in trend analysis affect coverage estimates for maternal and child health indicators? An analysis of DHS and MICS survey data

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The Inverse Equity Hypothesis: Analyses of Institutional Deliveries in 286 National Surveys

“…However, in a study from Mozambique with observation of obstetric care in facilities followed by a questionnaire applied at home 8 to 10 months later, the indicator with the highest validity (sensitivity and specificity around 80%) was whether the woman had delivered in a hospital versus a health center. 25 It is reasonable to expect that, if women can discriminate well between different types of facilities, information on whether the delivery took place on any institution or in the home would have even higher validity. Information on skilled birth attendants was available in a smaller number of surveys, and results were virtually identical to those for coverage with institutional deliveries as expected because of the high correlation between the 2 indicators (Pearson's r = 0.956; P < .001).…”

“…24 Growing availability of data from low-and middle-income countries allowed us to test the hypothesis in national surveys that provided information on socioeconomic position and on the proportion of births occurring in a health facility (institutional delivery coverage). We chose this outcome because it is measured in many surveys with high validity, 25 usually presenting marked socioeconomic gradients, 26,27 and because delivery by a skilled attendant in a health facility is a key intervention to reduce maternal and newborn mortality.…”