The Skilled Attendance Index: Proposal for a New Measure of Skilled Attendance at Delivery

Abstract

Increasing the proportion of deliveries with skilled attendance is widely regarded as key to reducing maternal mortality and morbidity in developing countries. The percentage of deliveries with a health professional is commonly used to assess skilled attendance, but measures only the presence of an attendant, not the skills used or the enabling environment. To supplement currently available information on the presence of an attendant at delivery, a method to measure the extent of skilled attendance at delivery through use of clinical records was devised. Data were collected from 416 delivery records in hospitals, government health centres and private non-hospital maternity facilities servicing Kintampo District, Ghana, using a case extraction form. Based on the defined criteria, summary measures of skilled attendance were calculated. Between 32.6% and 93.0% of the criteria for skilled attendance were met in the sample, with a mean of 65.5%. No delivery met all the criteria. A Skilled Attendance Index (SAI) was developed as a composite measure of delivery care. The SAI revealed that 26.9% of delivery records met at least three-quarters of the criteria for skilled attendance. Documentation of haemoglobin, current pregnancy complications, post-partum vital signs and completed partographs were amongst the criteria most poorly recorded. The purpose of applying these measures should be seen not as an end in itself but to advance improvements in delivery care. A 2004 Reproductive Health Matters. All rights reserved.Keywords: safe motherhood, skilled attendance at birth, delivery care, Ghana I NCREASING the proportion of deliveries with skilled attendance is now being promoted as an important approach to reducing maternal mortality and morbidity in developing countries. This is reflected in the published literature, 1,2 international initiatives 3 and safe motherhood programmes. 4 Current knowledge on the link between skilled attendance and maternal mortality is documented, as well as the limitations of the evidence.5 Skilled attendance is defined as ''the process by which a woman is provided with adequate care during labour, delivery and the early post-partum period' ' . 6 This requires a skilled person to attend the delivery and an enabling environment, including adequate supplies, equipment, transport and drugs. The indicator most commonly used to measure skilled attendance is the percentage of deliveries with a health professional, the information usually being obtained from community-based surveys by asking women to identify the attendant at each of their deliveries over the past three to five years. Much importance is placed on this indicator, and it is currently being used to measure achievement of the international Millennium Development Goal on maternal health. 7Data for this indicator are widely regarded as simple to collect, but the indicator is only a proxy measure of skilled attendance for several reasons. Firstly, only the presence of the health professional is measured, not their skills, and i...

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“…Our findings are consistent with those from other studies in African countries and the Dominican Republic, Jamaica and Ecuador. [8][9][10][11][12][13][14][15]17,18 Studies have consistently shown a lack of systematic monitoring of maternal or foetal signs during labour or progress of labour, 8,[10][11][12][13]15,17 low or incorrect use of the partograph, 13,15,[17][18][19][20] and poor postpartum care for both mother and baby. 8,11,12,15 The low technical performance in terms of monitoring of labour is perhaps not surprising given the extremely short length of stay of the women in the delivery ward.…”

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