Minimum obstetric volume in low-income countries

Straneo, Manuela; Hanson, Claudia; Fogliati, Piera; Mbaruku, Godfrey

doi:10.1016/s0140-6736(17)30342-2

Cited by 8 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…45 Most high-income and many middle-income countries encourage delivery in hospitals where surgical and newborn care services are available to all women. 46 Organising health system services around the capacity to deliver high-quality care may thus respond to women’s observed preferences and improve health system performance. The breadth of quality deficits in CHCs and especially PHCs, which are under-resourced despite concerted efforts and investment of the NHM, is concerning.…”

Section: Discussionmentioning

confidence: 99%

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

et al. 2018

View full text Add to dashboard Cite

ObjectivesTo assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states.DesignCross-sectional study.SettingData from the nationally representative 2012–2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India.Participants8536 PHCs and 4810 CHCs.Outcome measuresWe developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location.ResultsAbout 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise.ConclusionsBasic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and emergency service availability are urgently required.

show abstract

Section: Discussionmentioning

confidence: 99%

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In univariate analyses, we also found evidence that care competence may be higher in higher‐volume facilities and those with caesarean section capacity. The effects of delivery volumes on quality of care have been studied in high‐income settings, and evidence indicates improved neonatal survival and fewer complications in higher‐volume facilities . In LMICs, studies have shown better maternity care quality, better inpatient care quality for small and sick newborns, and better maternal and newborn care provider knowledge in busier facilities compared to low case‐load facilities .…”

Section: Discussionmentioning

confidence: 99%

Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys

Arsenault

English

Gathara

et al. 2020

Tropical Med Int Health

View full text Add to dashboard Cite

objective Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care.methods We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable randomintercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient-, provider-and facility-level and subnational divisions).results Only 61-66% of basic elements of competent and respectful care were performed. In adjusted models, better-staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV-positive women received higher-quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage-point gap between Nairobi and the Coast region. Quality was also higher in highervolume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient-level characteristics in Malawi.conclusions Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher-volume facilitiesalong with promotion of respectful care in these facilities should be considered in sub-Saharan Africa to improve outcomes for mothers and newborns.keywords quality, labour, childbirth, health systems research, sub-Saharan Africa Sustainable Development Goals (SDGs): SDG 3 (good health and well-being), SDG 5 (gender equity), SDG 9 (industry, innovation and infrastructure), SDG 10 (reduced inequalities), SDG 17 (partnerships for the goals)

show abstract

“…In published literature, this is the first study that has explored a relation between MWH utilization and socio-economic status controlling for confounders, in high institutional delivery coverage. This is particularly important in limited resources contexts with expanding rural health systems, where contrasts between coverage and quality of care become evident ( Hanson et al 2015 ; Straneo et al 2017 ). Further studies are required to validate this result, and to address questions that arise from it.…”

Section: Discussionmentioning

confidence: 99%

“…Poorest women are more likely to access delivery care in the primary health care system where lower quality is available, and are under-represented where comprehensive emergency obstetric care (C-EmOC) is provided ( Straneo et al 2014 ). Though thresholds on optimal delivery volumes in primary care are a matter of debate ( Kruk et al 2016 ; Straneo et al 2017 ), compelling evidence on the impact of limited quality in the peripheral component of the health system comes from a population survey in Tanzania, where direct maternal mortality reduced with proximity to a hospital, but not to any facility ( Hanson et al 2015 ). Quality of front-line delivery care in Tanzania has been found to be weak in different studies ( Hanson et al 2013 ; Kruk et al 2016 ; Mkoka et al 2014 ; Penfold et al 2013 ).…”

Section: Introductionmentioning

confidence: 99%

A new use for an old tool: maternity waiting homes to improve equity in rural childbirth care. Results from a cross-sectional hospital and community survey in Tanzania

Fogliati

Straneo

Mangi

et al. 2017

Health Policy and Planning

Self Cite

View full text Add to dashboard Cite

Limited quality of childbirth care in sub-Saharan Africa primarily affects the poor. Greater quality is available in facilities providing advanced management of childbirth complications. We aimed to determine whether Maternity Waiting Homes (MWHs) may be a tool to improve access of lower socio-economic women to such facilities. Secondary analysis of a cross-sectional hospital survey from Iringa District, Tanzania was carried out. Women who delivered between October 2011 and May 2012 in the only District facility providing comprehensive Emergency Obstetric Care were interviewed. Their socio-economic profile was obtained by comparison with District representative data. Multivariable logistic regression was used to compare women who had stayed in the MWH before delivery with those who had accessed the hospital directly. Out of 1072 study participants, 31.3% had accessed the MWH. In multivariable analysis, age, education, marital status and obstetric factors were not significantly associated with MWH stay. Adjusted odds ratios for MWH stay increased progressively with distance from the hospital (women living 6–25 km, OR 4.38; 26–50 km, OR 4.90; >50 km, OR 5.12). In adjusted analysis, poorer women were more likely to access the MWH before hospital delivery compared with the wealthiest quintile (OR 1.38). Policy makers should consider MWH as a tool to mitigate inequity in rural childbirth care.

show abstract

Minimum obstetric volume in low-income countries

Cited by 8 publications

References 5 publications

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys

A new use for an old tool: maternity waiting homes to improve equity in rural childbirth care. Results from a cross-sectional hospital and community survey in Tanzania

Contact Info

Product

Resources

About