Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis

Abstract

BackgroundImproving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in low- and middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care.MethodsThe 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15–49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique.ResultsThe negative binomial regression results identified a number of determinants of quality, such as the level of health facilities, managing authority, presence of delivery fee, central electricity supply and clinical guideline for maternal and neonatal care. Our structural equation modeling (SEM) further demonstrated that facility characteristics were important determinants of quality for initial assessment and postpartum care, while characteristics at the provider level became more important in shaping the quality of intrapartum care. Furthermore we also noted that quality of initial assessment had a positive association with quality of intrapartum care (β = 0.71, p < 0.001), which in turn was positively associated with the quality of newborn and immediate postpartum care (β = 1.29, p = 0.004).ConclusionsA continued focus on quality of care along the continuum of maternity care is important not only to mothers but also their newborns. Policymakers should therefore ensure that required resources, as well as adequate supervision and emphasis on the quality of obstetric care, are available.

Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs)

“…The 2000 World Health Report devoted substantial portions to making health systems respond to users’ expectations [ 11 ]. Following the report, studies on health systems responsiveness, in part, viewed as the quality of care has increased in the last two decades [ 12 , 13 ]. Quality of health care is generally framed as the level of service provision that meets the expectations of individuals and patients [ 14 ].…”

Factors contributing to regional inequalities in acute respiratory infections symptoms among under-five children in Nigeria: a decomposition analysis

“…We used both descriptive and logistic regression for complex survey were carried out to assess determinants of ARI symptoms. We ensured national representativeness; weighting factors were employed in this study to adjust for over sampling of some areas and under-sampling of others in the Demographic and Health Survey by using sampling weights using Taylor series linearization method [ 48 , 49 ]. Structurally, two indicators of inequality in the distribution of ARI symptoms namely Gini index [ 50 ] and Concentration index [ 51 ] were estimated.…”

Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study

“…Previously, adverse outcomes were thought to result primarily from delivery occurring outside of health facilities and from lack of access to skilled care [3][4]. However, a recent literature review showed more women in low income countries are delivering in facilities but this shift has not been consistently linked to mortality reduction nor guaranteed that appropriate interventions are rendered during the intra-partum and immediate postpartum period in settings which may result in low quality of care (QoC) [5][6][7]. Strategies such as the Janani Suraksha Yojana (JSY) program, a large conditional cash transfer programs in India, have increased rates of facility-based childbirth without significantly decreasing maternal and neonatal mortality [6,8].…”

“…However, a recent literature review showed more women in low income countries are delivering in facilities but this shift has not been consistently linked to mortality reduction nor guaranteed that appropriate interventions are rendered during the intra-partum and immediate postpartum period in settings which may result in low quality of care (QoC) [5][6][7]. Strategies such as the Janani Suraksha Yojana (JSY) program, a large conditional cash transfer programs in India, have increased rates of facility-based childbirth without significantly decreasing maternal and neonatal mortality [6,8]. This finding implies improving the QoC provided during facilitybased childbirth is key to decreasing maternal and neonatal mortality and complications [9,10].…”