Patrick Opiyo Owili1,2,3, Miriam Adoyo Muga4, Bomar Rojas Mendez5, Bradley Chen5,6. 1. Department of Public Health, University of Eastern Africa, Baraton, Eldoret, Kenya. 2. Master of Public Health Program and Master in Global Health Program, School of Health Sciences, University of Eastern Africa, Baraton, Eldoret, Kenya. 3. Institute of Environmental & Occupational Health Sciences, National Yang Ming University, Taipei, Taiwan. 4. Department of Foods, Nutrition and Dietetics, School of Science and Technology, University of Eastern Africa, Baraton, Eldoret, Kenya. 5. International Health Program, National Yang Ming University, Taipei, Taiwan. 6. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Abstract
OBJECTIVE: Quality of care may help explain the high burden of disease in maternal, newborn and child health in low- and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA). DESIGN: Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence interval (CI). SETTING: We used Service Provision Assessment data from six countries in SSA, including Kenya, Malawi, Namibia, Rwanda, Tanzania and Uganda. PARTICIPANTS: Seven thousand, five hundred and seventy seven observed antenatal clients across the six countries. MAIN OUTCOME MEASURES: Quality of ANC services, measured using indexes of quality of clinical care and quality of information provided. RESULTS: Providers in facilities that had ANC guideline (AOR = 1.26; 95% CI, 1.08-1.48), were well-equipped (AOR = 1.65; 95% CI, 1.41-1.92), were classified as upper level facility (AOR = 1.32; 95% CI, 1.05-1.66), had central electricity supply (AOR = 2.19; 95% CI, 1.81-2.65), and piped water (AOR = 1.30; 95% CI, 1.09-1.55) were more likely to provide optimal quality of clinical care. Moreover, those having ANC guideline (AOR = 1.81; 95% CI, 1.43-2.28) and central electricity supply (AOR = 2.67; 95% CI, 2.01-3.44) were more likely to provide optimal information as well. Provider's qualification and experience were also important in information provision and clinical care independently. CONCLUSION: The lack of some very basic facility equipment and amenities compromised quality of care in sub-Saharan countries. Policy actions and investment on facility and providers will enable provision of quality services necessary to improve maternal, newborn and child health in SSA.
OBJECTIVE: Quality of care may help explain the high burden of disease in maternal, newborn and child health in low- and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA). DESIGN: Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence interval (CI). SETTING: We used Service Provision Assessment data from six countries in SSA, including Kenya, Malawi, Namibia, Rwanda, Tanzania and Uganda. PARTICIPANTS: Seven thousand, five hundred and seventy seven observed antenatal clients across the six countries. MAIN OUTCOME MEASURES: Quality of ANC services, measured using indexes of quality of clinical care and quality of information provided. RESULTS: Providers in facilities that had ANC guideline (AOR = 1.26; 95% CI, 1.08-1.48), were well-equipped (AOR = 1.65; 95% CI, 1.41-1.92), were classified as upper level facility (AOR = 1.32; 95% CI, 1.05-1.66), had central electricity supply (AOR = 2.19; 95% CI, 1.81-2.65), and piped water (AOR = 1.30; 95% CI, 1.09-1.55) were more likely to provide optimal quality of clinical care. Moreover, those having ANC guideline (AOR = 1.81; 95% CI, 1.43-2.28) and central electricity supply (AOR = 2.67; 95% CI, 2.01-3.44) were more likely to provide optimal information as well. Provider's qualification and experience were also important in information provision and clinical care independently. CONCLUSION: The lack of some very basic facility equipment and amenities compromised quality of care in sub-Saharan countries. Policy actions and investment on facility and providers will enable provision of quality services necessary to improve maternal, newborn and child health in SSA.