Louise Tina Day1, Qazi Sadeq-Ur Rahman2, Ahmed Ehsanur Rahman2, Nahya Salim3, Ashish Kc4, Harriet Ruysen5, Tazeen Tahsina2, Honorati Masanja6, Omkar Basnet7, Georgia R Gore-Langton5, Sojib Bin Zaman2, Josephine Shabani6, Anjani Kumar Jha8, Vladimir Sergeevich Gordeev9, Shafiqul Ameen2, Donat Shamba6, Bijay Jha8, Dorothy Boggs5, Tanvir Hossain2, Kizito Shirima6, Ram Chandra Bastola10, Kimberly Peven11, Abu Bakkar Siddique2, Godfrey Mbaruku6, Rajendra Paudel7, Angela Baschieri5, Aniqa Tasnim Hossain2, Stefanie Kong5, Asmita Paudel7, Anisuddin Ahmed2, Simon Cousens5, Shams El Arifeen2, Joy E Lawn5. 1. Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: louise-tina.day@lshtm.ac.uk. 2. Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh. 3. Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania. 4. International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. 5. Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK. 6. Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania. 7. Research Division, Golden Community, Lalitpur, Kathmandu, Nepal. 8. Nepal Health Research Council, Kathmandu, Nepal. 9. Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK; The Institute of Population Health Sciences, Queen Mary University of London, London, UK. 10. Pokhara Academy of Health Science, Pokhara, Nepal; Ministry of Health and Population, Kathmandu, Nepal. 11. Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
Abstract
BACKGROUND: Progress in reducing maternal and neonatal deaths and stillbirths is impeded by data gaps, especially regarding coverage and quality of care in hospitals. We aimed to assess the validity of indicators of maternal and newborn health-care coverage around the time of birth in survey data and routine facility register data. METHODS: Every Newborn-BIRTH Indicators Research Tracking in Hospitals was an observational study in five hospitals in Bangladesh, Nepal, and Tanzania. We included women and their newborn babies who consented on admission to hospital. Exclusion critiera at admission were no fetal heartbeat heard or imminent birth. For coverage of uterotonics to prevent post-partum haemorrhage, early initiation of breastfeeding (within 1 h), neonatal bag-mask ventilation, kangaroo mother care (KMC), and antibiotics for clinically defined neonatal infection (sepsis, pneumonia, or meningitis), we collected time-stamped, direct observation or case note verification data as gold standard. We compared data reported via hospital exit surveys and via hospital registers to the gold standard, pooled using random effects meta-analysis. We calculated population-level validity ratios (measured coverage to observed coverage) plus individual-level validity metrics. FINDINGS: We observed 23 471 births and 840 mother-baby KMC pairs, and verified the case notes of 1015 admitted newborn babies regarding antibiotic treatment. Exit-survey-reported coverage for KMC was 99·9% (95% CI 98·3-100) compared with observed coverage of 100% (99·9-100), but exit surveys underestimated coverage for uterotonics (84·7% [79·1-89·5]) vs 99·4% [98·7-99·8] observed), bag-mask ventilation (0·8% [0·4-1·4]) vs 4·4% [1·9-8·1]), and antibiotics for neonatal infection (74·7% [55·3-90·1] vs 96·4% [94·0-98·6] observed). Early breastfeeding coverage was overestimated in exit surveys (53·2% [39·4-66·8) vs 10·9% [3·8-21·0] observed). "Don't know" responses concerning clinical interventions were more common in the exit survey after caesarean birth. Register data underestimated coverage of uterotonics (77·9% [37·8-99·5] vs 99·2% [98·6-99·7] observed), bag-mask ventilation (4·3% [2·1-7·3] vs 5·1% [2·0-9·6] observed), KMC (92·9% [84·2-98·5] vs 100% [99·9-100] observed), and overestimated early breastfeeding (85·9% (58·1-99·6) vs 12·5% [4·6-23·6] observed). Inter-hospital heterogeneity was higher for register-recorded coverage than for exit survey report. Even with the same register design, accuracy varied between hospitals. INTERPRETATION: Coverage indicators for newborn and maternal health care in exit surveys had low accuracy for specific clinical interventions, except for self-report of KMC, which had high sensitivity after admission to a KMC ward or corner and could be considered for further assessment. Hospital register design and completion are less standardised than surveys, resulting in variable data quality, with good validity for the best performing sites. Because approximately 80% of births worldwide take place in facilities, standardising register design and information systems has the potential to sustainably improve the quality of data on care at birth. FUNDING: Children's Investment Fund Foundation and Swedish Research Council.
BACKGROUND: Progress in reducing maternal and neonatal deaths and stillbirths is impeded by data gaps, especially regarding coverage and quality of care in hospitals. We aimed to assess the validity of indicators of maternal and newborn health-care coverage around the time of birth in survey data and routine facility register data. METHODS: Every Newborn-BIRTH Indicators Research Tracking in Hospitals was an observational study in five hospitals in Bangladesh, Nepal, and Tanzania. We included women and their newborn babies who consented on admission to hospital. Exclusion critiera at admission were no fetal heartbeat heard or imminent birth. For coverage of uterotonics to prevent post-partum haemorrhage, early initiation of breastfeeding (within 1 h), neonatal bag-mask ventilation, kangaroo mother care (KMC), and antibiotics for clinically defined neonatal infection (sepsis, pneumonia, or meningitis), we collected time-stamped, direct observation or case note verification data as gold standard. We compared data reported via hospital exit surveys and via hospital registers to the gold standard, pooled using random effects meta-analysis. We calculated population-level validity ratios (measured coverage to observed coverage) plus individual-level validity metrics. FINDINGS: We observed 23 471 births and 840 mother-baby KMC pairs, and verified the case notes of 1015 admitted newborn babies regarding antibiotic treatment. Exit-survey-reported coverage for KMC was 99·9% (95% CI 98·3-100) compared with observed coverage of 100% (99·9-100), but exit surveys underestimated coverage for uterotonics (84·7% [79·1-89·5]) vs 99·4% [98·7-99·8] observed), bag-mask ventilation (0·8% [0·4-1·4]) vs 4·4% [1·9-8·1]), and antibiotics for neonatal infection (74·7% [55·3-90·1] vs 96·4% [94·0-98·6] observed). Early breastfeeding coverage was overestimated in exit surveys (53·2% [39·4-66·8) vs 10·9% [3·8-21·0] observed). "Don't know" responses concerning clinical interventions were more common in the exit survey after caesarean birth. Register data underestimated coverage of uterotonics (77·9% [37·8-99·5] vs 99·2% [98·6-99·7] observed), bag-mask ventilation (4·3% [2·1-7·3] vs 5·1% [2·0-9·6] observed), KMC (92·9% [84·2-98·5] vs 100% [99·9-100] observed), and overestimated early breastfeeding (85·9% (58·1-99·6) vs 12·5% [4·6-23·6] observed). Inter-hospital heterogeneity was higher for register-recorded coverage than for exit survey report. Even with the same register design, accuracy varied between hospitals. INTERPRETATION: Coverage indicators for newborn and maternal health care in exit surveys had low accuracy for specific clinical interventions, except for self-report of KMC, which had high sensitivity after admission to a KMC ward or corner and could be considered for further assessment. Hospital register design and completion are less standardised than surveys, resulting in variable data quality, with good validity for the best performing sites. Because approximately 80% of births worldwide take place in facilities, standardising register design and information systems has the potential to sustainably improve the quality of data on care at birth. FUNDING: Children's Investment Fund Foundation and Swedish Research Council.
Authors: Donat Shamba; Louise T Day; Joy E Lawn; Sojib Bin Zaman; Avinash K Sunny; Menna Narcis Tarimo; Kimberly Peven; Jasmin Khan; Nishant Thakur; Md Taqbir Us Samad Talha; Ashish K C; Rajib Haider; Harriet Ruysen; Tapas Mazumder; Md Hafizur Rahman; Md Ziaul Haque Shaikh; Johan Ivar Sæbø; Claudia Hanson; Neha S Singh; Joanna Schellenberg; Lara M E Vaz; Jennifer Requejo Journal: BMC Pregnancy Childbirth Date: 2021-03-26 Impact factor: 3.007
Authors: Miriam E Gladstone; Nahya Salim; Karama Ogillo; Donat Shamba; Georgia R Gore-Langton; Louise T Day; Hannah Blencowe; Joy E Lawn Journal: BMC Pregnancy Childbirth Date: 2021-03-26 Impact factor: 3.007
Authors: Stefanie Kong; Louise T Day; Hannah Blencowe; Joy E Lawn; Sojib Bin Zaman; Kimberly Peven; Nahya Salim; Avinash K Sunny; Donat Shamba; Qazi Sadeq-Ur Rahman; Ashish K C; Harriet Ruysen; Shams El Arifeen; Paul Mee; Miriam E Gladstone Journal: BMC Pregnancy Childbirth Date: 2021-03-26 Impact factor: 3.007