Measuring effective coverage of maternal and child health services in Cambodia: a retrospective analysis of Demographic and Health Surveys from 2005 to 2014

Abstract

ObjectiveTo investigate effective, quality-adjusted, coverage and inequality of maternal and child health (MCH) services to assess progress in improving quality of care in Cambodia.DesignA retrospective secondary analysis using the three most recent (2005, 2010 and 2014) Demographic and Health Surveys.SettingCambodia.Participants53 155 women aged 15–49 years old and 23 242 children under 5 years old across the three surveys.Outcome measuresWe estimated crude coverage, effective coverage and inequality in effective coverage for five MCH services over time: antenatal care (ANC), facility delivery and sick childcare for diarrhoea, pneumonia and fever. Quality was defined by the proportion of care seekers who received a set of interventions during healthcare visits. Effective coverage was estimated by combining crude coverage and quality. We used equiplots and risk ratios, to assess patterns in inequality in MCH effective coverage across wealth quintile, urban–rural and women’s education levels and over time.ResultsIn 2014, crude and effective coverage was 80.1% and 56.4%, respectively, for maternal health services (ANC and facility delivery) and 59.1% and 26.9%, respectively, for sick childcare (diarrhoea, pneumonia and fever). Between 2005 and 2014, effective coverage improved for all services, but improvements were larger for maternal healthcare than for sick child care. In 2014, poorer children were more likely to receive oral rehydration solution for diarrhoea than children from richer households. Meanwhile, women from urban areas were more likely to receive a postnatal check before getting discharged.ConclusionsEffective coverage has generally improved in Cambodia but efforts remain to improve quality for all MCH services. Our results point to substantial gaps in curative sick child care, a large share of which is provided by unregulated private providers in Cambodia. Policymakers should focus on improving effective coverage, and not only crude coverage, to achieve the health-related Sustainable Development Goals by 2030.

i-MoMCARE: Innovative Mobile Technology for Maternal and Child Health Care in Cambodia—study protocol of a cluster randomized controlled trial

“…We will use the MCH coverage index to evaluate the effectiveness of the intervention. We have conjectured that the coverage rate should be well above 60% to be meaningful since earlier estimates of the compelling national coverage of maternal health services (ANC and facility delivery) and sick childcare (diarrhea, pneumonia, and fever) in 2014 were 56.4% and 59.1%, respectively [ 33 ]. Another recent study using a slightly deviated measure of the mother and infant care continuum shows that the national coverage was 49.4% [ 34 ].…”

Effective Coverage of Management of Wasting in Ethiopia

“…While the notion of effective coverage holds significance, most studies addressing this area have centered on antenatal care (ANC), postnatal care, facility delivery, family planning, HIV, sick childcare, and growth monitoring [13][14][15][16][17][18][19][20]. Notably, investigations focusing specifically on the management of wasting remain scarce.…”

Effective coverage for maternal health: operationalizing effective coverage cascades for antenatal care and nutrition interventions for pregnant women in seven low- and middle-income countries

“…Munos et al recently set forth a set of best practices for generating estimates for effective coverage cascades using both household survey (HHS) data and health facility assessment (HFA) data [27]. Exley et al have explored operationalizing the coverage cascade for facility-based childbirth interventions using HHS data and two sources of health facility data (HFA and routine health information data) [28] while Kim et al explored generating effective coverage estimates for maternal and newborn health services using HHS data [29]. The aim of this study was to operationalize effective coverage cascades for ANC and for maternal nutrition services delivered during ANC using extant nationally representative, publicly available data in LMICs.…”