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

Abstract

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)

Facility-Level Determinants of Quality Routine Intrapartum Care in Afghanistan

“…These results are concerning such that no facility type reached an average quality of care score above 56%. Frequency of performance of many items was similar to that observed in four African countries where the index was validated [24], and overall scores were slightly lower than those measured in SPA surveys including direct observation of intrapartum care in Kenya and Malawi [26]. However, quality of care was variable across health facility type and stage of labor within each facility type.…”

Understanding what women want: eliciting preference for delivery health facility in a rural subcounty in Kenya, a discrete choice experiment

“…9 The quality of care provided also differs substantively across regions in Kenya with one study identifying a 25-percentage point gap between Nairobi and Coast regions. 10 Additionally, higher volume facilities and those with caesarean section capacity seemed to offer a high quality of care. 10 There have also been recent reports of increased utilisation of county-level (referral) hospitals for deliveries.…”

“…10 Additionally, higher volume facilities and those with caesarean section capacity seemed to offer a high quality of care. 10 There have also been recent reports of increased utilisation of county-level (referral) hospitals for deliveries. 11 National assessments of quality of care at health facilities in Kenya suggest that poorer women have a higher likelihood of encountering poor quality of maternal health services in Kenya.…”

Exploring women’s childbirth experiences and perceptions of delivery care in peri-urban settings in Nairobi, Kenya

“…Regional variations in quality of care have also been reported, with women in coastal Kenya receiving poorer quality delivery services as compared to city settings. The same study also showed that high-volume health facilities provide better quality of care [ 12 ]. Further, several studies in low and middle-income countries (LMICs), including in Kenya, have documented mistreatment and disrespect, and abuse as a challenge for women during childbirth—highlighting gaps in person-centered maternity care [ 13 – 16 ].…”