Measuring Quality of Maternal and Newborn Care in Developing Countries Using Demographic and Health Surveys

Abstract

BackgroundOne of the greatest obstacles facing efforts to address quality of care in low and middle income countries is the absence of relevant and reliable data. This article proposes a methodology for creating a single “Quality Index” (QI) representing quality of maternal and neonatal health care based upon data collected as part of the Demographic and Health Survey (DHS) program.MethodsUsing the 2012 Indonesian Demographic and Health Survey dataset, indicators of quality of care were identified based on the recommended guidelines outlined in the WHO Integrated Management of Pregnancy and Childbirth. Two sets of indicators were created; one set only including indicators available in the standard DHS questionnaire and the other including all indicators identified in the Indonesian dataset. For each indicator set composite indices were created using Principal Components Analysis and a modified form of Equal Weighting. These indices were tested for internal coherence and robustness, as well as their comparability with each other. Finally a single QI was chosen to explore the variation in index scores across a number of known equity markers in Indonesia including wealth, urban rural status and geographical region.ResultsThe process of creating quality indexes from standard DHS data was proven to be feasible, and initial results from Indonesia indicate particular disparities in the quality of care received by the poor as well as those living in outlying regions.ConclusionsThe QI represents an important step forward in efforts to understand, measure and improve quality of MNCH care in developing countries.

Changes in obstetric case fatality and early newborn mortality rates in hospitals after the implementation of the Expanding Maternal and Neonatal Survival program in Indonesia: Results from a health information system

“…Only 29.4% of maternal deaths occurred at the home. Several studies have suggested that poor quality of maternal care at health facilities in Indonesia contributes to high maternal mortality . A study in Papua province suggests poor quality and delays in receiving appropriate care at facilities are the major causes of maternal mortality …”

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

“…For instance, Demographic and Health Surveys (DHS) do not collect information on patient satisfaction and safety or health inputs or system efficiency. 22) To overcome this data constraint, prior studies have often used caesarean and episiotomy rates, 23) neonatal near-miss events (i.e., newborn infants presenting selected markers of severity and surviving the first neonatal week), 24) and maternal mortality as proxy indicators for quality of care. Another recent study used principal components analysis based techniques to quantify variation in quality of care using core DHS indicators for Indonesia and found disparities by wealth and geographical regions.…”

“…Another recent study used principal components analysis based techniques to quantify variation in quality of care using core DHS indicators for Indonesia and found disparities by wealth and geographical regions. 22) We offer a fairly new approach to derive contextual provider quality indicators and assess their relative importance along with individual utilization of ANC and SBA in India using multilevel framework. This study uses the latest nationally representative data from India to first create indicators for district and state provider quality based on residuals deviating from the ecological associations between ANC (and SBA) rate and prevalence of neonatal, infant, and under-five mortality at each respective level.…”

A new content-qualified antenatal care coverage indicator: development and validation of a score using national health surveys

“…13 Several authors have proposed different types of quality indicators for ANC. 3,[5][6][7][8]12,[14][15][16][17] Some have proposed binary indicators (e.g. good vs. poor quality) [5][6][7] or categorical classifications (e.g.…”

“…In most studies, good quality in ANC was defined as having received all or most of the components considered. 5,6,15,16 Another strategy to create a "quality index" was proposed by Dettrick et al using data from Indonesia, 17 by principal components analysis to derive weights and calculate a score.…”