Measuring Coverage in MNCH: Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic

Abstract

BackgroundCesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR).Methods and FindingsThis study compares hospital-based data, considered the reference standard, against women’s self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic.ConclusionsQuestions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires. Additional studies which confirm the accuracy of key facility-based indicators in advance of data collection and which use a longer recall period are warranted.

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.…”

Prevalence of Hypertensive Disorders in Pregnancy at Korle-Bu Teaching Hospital in Ghana

“…In the hospital, the National Health Insurance (NHI) free delivery scheme covers all the pregnant women who access the maternity services. The maternity unit of the hospital conducts over 10,000 deliveries annually with a caesarean rate of about 35% [17] . Antenatal care is offered on daily basis from Monday to Friday at Maternity unit and about 200 pregnant women attend antenatal clinic daily.…”

Measuring Coverage in MNCH: New Findings, New Strategies, and Recommendations for Action

“…We conducted studies of this type for emergency cesarean sections in Ghana and the Dominican Republic [20], a broad range of interventions delivered around the time of birth (the peripartum period) in Mozambique [21], diagnosis and antibiotic treatment of childhood pneumonia in Pakistan and Bangladesh [22], diagnosis and treatment of malaria in Zambia [23], and selected services across the MNCH continuum of care in a rural population in China [24]. Table 1 presents findings on sensitivity, specificity, and accuracy for a subset of the indicators assessed in the research studies, focusing on global consensus coverage indicators currently in use and indicators closely related to these accepted coverage indicators.…”

“…We believe for the same reason that applying standard cutoff values for acceptable levels of accuracy is not appropriate in this situation. True/actual positives ratios or their mathematical equivalents are presented in the individual papers [20],[21],[23],[24].…”