College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Tigray Region Health Bureau, Mekelle, Tigray, Ethiopia.
Reprod Health. 2020 May 24;17(1):73. doi: 10.1186/s12978-020-00923-w.
Measurement of quality of health care has been largely overlooked and continues to be a major health system bottleneck in monitoring performance and quality to evaluate progress against defined targets for better decision making. Hence, metrics of maternity care are needed to advance from health service contact alone to content of care. We assessed the accuracy of indicators that describe the quality of basic care for childbirth functions both at the individual level as well as at the population level in Northern Ethiopia.
A validation study was conducted by comparing women's self-reported coverage of maternal and newborn health interventions during intra-partum and immediate postpartum care received in primary level care facilities of Northern Ethiopia against a gold standard of direct observation by a trained third party (n = 478). Sensitivity, specificity and individual-level reporting accuracy via the area under the receiver operating curve (AUC) and inflation factor (IF) to estimate population-level accuracy for each indicator was applied for validity analysis.
455(97.5%) of women completed the survey describing health interventions. Thirty-two (43.2%) of the 93-basic quality child birth care indicators that were assessed could be accurately measure at the facility and population level (AUC > 0.60 and 0.75 < IF< 1.25). Few of the valid indicators were: whether women and their companion were greeted respectfully, whether an HIV test was offered, and whether severe bleeding (hemorrhage) was experienced by the woman. An additional 21(28.4%) indicators accurately measure at the facility or individual level, but the indicators under or over estimate at population level. Thirteen other indicators could accurately measure at population level. Eight (8.6%) indicators didn't meet either of the validity criteria.
Women were able to accurately report on several indicators of quality for basic child birth care. For those few indicators that required a technical understanding tended to have higher don't know response from the women. Therefore, valid indicators should be included as a potential measurement of quality for the childbirth care process to ensure that essential interventions are delivered.
医疗保健质量的衡量在很大程度上被忽视，并且仍然是监测绩效和质量以评估针对特定目标的进展的主要卫生系统瓶颈，以便做出更好的决策。因此，需要产妇保健指标来将医疗服务接触的内容扩展到护理内容。我们评估了在埃塞俄比亚北部，个体层面和人群层面上描述分娩功能基本护理质量的指标的准确性。
通过将妇女在初级保健设施接受的分娩期间和产后立即接受的母婴健康干预措施的自我报告覆盖率与经过培训的第三方的直接观察进行比较（n=478），进行了一项验证研究，这是一个金标准。应用接受者操作特征曲线（AUC）下的面积和膨胀因子（IF）来计算每个指标的个体水平报告准确性和人口水平准确性，以进行有效性分析。
455 名（97.5%）妇女完成了描述卫生干预措施的调查。在所评估的 93 个基本生育护理质量指标中，有 32 个（43.2%）可以在设施和人群层面上准确测量（AUC>0.60 和 0.75<IF<1.25）。少数有效的指标包括：妇女及其同伴是否受到尊重的问候、是否提供艾滋病毒检测，以及妇女是否经历严重出血（出血）。另外 21 个指标（28.4%）在设施或个体层面上准确测量，但在人群层面上则过高或过低估计。还有 13 个其他指标可以在人群层面上准确测量。8 个（8.6%）指标不符合任何有效性标准。
妇女能够准确报告基本分娩护理质量的几个指标。对于那些需要技术理解的少数指标，妇女的“不知道”回答率较高。因此，应将有效的指标纳入分娩护理过程的潜在质量衡量标准，以确保提供必要的干预措施。
