GHSP: Household Survey Measurement of Newborn Postnatal Care: Coverage, Quality Gaps, and Internal Inconsistencies in Responses
Citation, abstract, key findings and comments from me below.
CITATION: Household Survey Measurement of Newborn Postnatal Care: Coverage, Quality Gaps, and Internal Inconsistencies in Responses
Kimberly Peven, Louise Tina Day, Debra Bick, Edward Purssell, Cath Taylor, Joseph Akuze and Lindsay Mallick
Global Health: Science and Practice November 2021, https://doi.org/10.9745/GHSP-D-21-00209
ABSTRACT
Background: Reliable measurement of newborn postnatal care is essential to understand gaps in coverage and quality and thereby improve outcomes. This study examined gaps in coverage and measurement of newborn postnatal care in the first 2 days of life.
Methods: We analyzed Demographic and Health Survey data from 15 countries for 71,366 births to measure the gap between postnatal contact coverage and content coverage within 2 days of birth. Coverage was a contact with the health system in the first 2 days (postnatal check or newborn care intervention), and quality was defined as reported receipt of 5 health worker-provided interventions. We examined internal consistency between interrelated questions regarding examination of the umbilical cord.
Results: Reported coverage of postnatal check ranged from 13% in Ethiopia to 78% in Senegal. Report of specific newborn care interventions varied widely by intervention within and between countries. Quality-coverage gaps were high, ranging from 26% in Malawi to 89% in Burundi. We found some internally inconsistent reporting of newborn care. The percentage of women who reported that a health care provider checked their newborn’s umbilical cord but responded “no” to the postnatal check question was as high as 16% in Malawi.
Conclusion: Reliable measurement of coverage and content of early postnatal newborn care is essential to track progress in improving quality of care. Postnatal contact coverage is challenging to measure because it may be difficult for women to distinguish postnatal care from intrapartum care and it is a less recognizable concept than antenatal care. Co-coverage measures may provide a useful summary of contact and content, reflecting both coverage and an aspect of quality.
KEY FINDINGS
- Reports of receipt of a newborn postnatal care check do not necessarily reflect adequate provision of interventions resulting in large gaps between reported contact coverage and recommended content of newborn postnatal care (26%–89%) in 15 low- and middle-income countries.
- We found internal inconsistencies in survey responses regarding receipt of newborn postnatal care (“no” to whether anyone checked on the newborn’s health, but “yes” to questions on specific newborn interventions), which were as high as 16% in Malawi.
COMMENTS (NPW):
1. The findings again emphasise (for me) the gap in provision of basic healthcare measures. More is needed to understand *why* such measures are not implemented.
2. 'Postnatal contact coverage is challenging to measure because it may be difficult for women to distinguish postnatal care from intrapartum care' - This issue could be addressed by having clearer guidance for health workers and mothers completing the survey, in a language they can understand.
3. 'We found internal inconsistencies in survey responses regarding receipt of newborn postnatal care (“no” to whether anyone checked on the newborn’s health, but “yes” to questions on specific newborn interventions), which were as high as 16% in Malawi.' Again, this suggests misunderestandings in relation to the questions and the need for better guidance.
4. I have not had a chance to review the paper in detail but it seems that it includes a heterogenous mix of home and facility based births. It may be helpful to disaggregate the findings?
5. What do we know about the information needs of parents and health workers with regards to basic newborn care? How can these needs be better addressed?
I look forward to hear your views.
Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org
