Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
J Glob Health. 2019 Dec;9(2):020411. doi: 10.7189/jogh.09.020411.
Improving the quality of facility-based births is a critical strategy for reducing the high burden of maternal and neonatal mortality and morbidity across all settings. Accurate data on childbirth care is essential for monitoring progress. In northeastern Nigeria, we assessed the validity of childbirth care indicators in a rural primary health care context, as documented by health workers and reported by women at different recall periods.
We compared birth observations (gold standard) to: (i) facility exit interviews with observed women; (ii) household follow-up interviews 9-22 months after childbirth; and (iii) health worker documentation in the maternity register. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. We calculated the inflation factor (IF) to determine population-level validity.
Twenty-five childbirth care indicators were assessed to validate health worker documentation and women's self-reports. During exit interviews, women's recall had high validity (AUC≥0.70 and 0.75<IF<1.25) for 9 of 20 indicators assessed; six additional indicators met either AUC or IF criteria for validity. During follow-up interviews, women's recall had high validity for one of 15 indicators assessed, placing the newborn skin-to-skin; two additional indicators met IF criteria only. Health worker documentation had high validity for four of 10 indicators assessed; three additional indicators met AUC or IF criteria.
In addition to standard household surveys, monitoring of facility-based childbirth care should consider drawing from and linking multiple data sources, including routine health facility data and exit interviews with recently delivered women.
在所有环境中，提高医疗机构分娩的质量是降低孕产妇和新生儿死亡率和发病率高负担的关键策略。准确的分娩护理数据对于监测进展至关重要。在尼日利亚东北部，我们评估了农村初级卫生保健环境中分娩护理指标的有效性，这些指标由卫生工作者记录并由妇女在不同的回忆期报告。
我们将分娩观察（金标准）与以下内容进行了比较：（i）与观察到的妇女进行的机构出院访谈；（ii）分娩后 9-22 个月的家庭随访访谈；（iii）产妇登记处的卫生工作者记录。我们计算了敏感性、特异性和接收器操作曲线下的面积（AUC），以确定个体报告的准确性。我们计算了膨胀系数（IF），以确定人口水平的有效性。
评估了 25 个分娩护理指标，以验证卫生工作者的记录和妇女的自我报告。在出院访谈中，妇女的回忆对 20 个评估指标中的 9 个具有很高的有效性（AUC≥0.70 和 0.75<IF<1.25）；另外六个指标符合 AUC 或 IF 标准的有效性。在随访访谈中，妇女的回忆对 15 个评估指标中的一个具有很高的有效性，新生儿皮肤对皮肤；另外两个指标仅符合 IF 标准。卫生工作者的记录对 10 个评估指标中的 4 个具有很高的有效性；另外三个指标符合 AUC 或 IF 标准。
除了标准的家庭调查外，还应考虑从多个数据源（包括常规卫生设施数据和最近分娩妇女的出院访谈）监测机构内的分娩护理。
