Measurement of respectful maternity care in exit interviews following facility childbirth: a criterion validity assessment in Nigeria

Background Valid methods for assessing women’s experiences of maternity care are essential to the global efforts toward providing positive childbirth environments for all women in all health facilities. Methods This criterion validity study used observation of childbirth as the reference standard compared to exit interviews with women upon discharge with a live baby, usually within 24 hours of childbirth. We investigated eight positive and sixteen negative maternity care experience indicators. Data were collected from ten primary healthcare facilities in Gombe State, northeast Nigeria, in August 2018 and August 2019. Data analysis involved tabulation of demographic characteristics of women and childbirth context, computation of individual level validity metrics including the area under the receiver operating curve (AUC) and estimating population level validity using the inflation factor (IF). Results A total of 724 women were observed and interviewed at the time of discharge (exit) following facility childbirth, 15% of whom were adolescents, 99% were married, 43% had no formal education, and a skilled birth attendant had attended only 12%. The prevalence of positive maternity care experience indicators ranged between 25% and 96% in childbirth observations. For these positive indicators, the agreement between childbirth observations and exit interviews ranged from 55% to 97%. Six of the eight positive maternity care experience indicators had high overall validity, meaning AUC≥0.70 and 0.75<IF<1.25, with high sensitivity (89% to 99%) and moderate to high specificity (44% to 84%). The prevalence of the 16 negative maternity care experience indicators ranged between 0.1% and 18% in childbirth observations. For these negative indicators, agreement ranged from 87% to 99%. Just six of the 16 negative maternity care experience indicators met the criteria for validation analysis; and these showed low to moderate sensitivity (32% to 74%), high specificity (97% to 100%) and moderate (0.60<AUC<0.70) to high (AUC≥0.70) individual-level validity. Conclusions In this high mortality setting with relatively low coverage of skilled attendance at birth, exit interviews with women following facility-based childbirth care provided responses consistent with the observation of childbirth for eight positive and six negative maternity care experience indicators

Household possession, use and non-use of treated or untreated mosquito nets in two ecologically diverse regions of Nigeria – Niger Delta and Sahel Savannah

<p>Abstract</p> <p>Background</p> <p>Current use of treated mosquito nets for the prevention of malaria falls short of what is expected in sub-Saharan Africa (SSA), though research within the continent has indicated that the use of these commodities can reduce malaria morbidity by 50% and malaria mortality by 20%. Governments in sub-Sahara Africa are investing substantially in scaling-up treated mosquito net coverage for impact. However, certain significant factors still prevent the use of the treated mosquito nets, even among those who possess them. This survey examines household ownership as well as use and non-use of treated mosquito nets in Sahel Savannah and Niger Delta regions of Nigeria.</p> <p>Methodology</p> <p>This survey employed cross-sectional survey to collect data from households on coverage and use of mosquito nets, whether treated or not. Fever episodes in previous two weeks among children under the age of five were also recorded. The study took place in August 1 – 14 2007, just five months after the March distribution of treated mosquito nets, coinciding with the second raining period of the year and a time of high malaria transmission during the wet season. EPI INFO version 2003 was used in data analysis.</p> <p>Results</p> <p>The survey covered 439 households with 2,521 persons including 739 under-fives, 585 women in reproductive age and 78 pregnant women in Niger Delta Region and Sahel Savannah Region. Of the 439 HHs, 232 had any mosquito nets. Significantly higher proportion of households in the Niger Delta Region had any treated or untreated mosquito nets than those in the Sahel Savannah Region. In the Niger Delta Region, the proportion of under-fives that had slept under treated nets the night before the survey exceeded those that slept under treated nets in the Sahel Savannah Region. Children under the age of five years in the Niger Delta Region were four times more likely to sleep under treated nets than those in the Sahel Savannah Region.</p> <p>Conclusion</p> <p>This study found that despite the fact that treated nets were distributed widely across Nigeria, the use of this commodity was still very low in the Sahel Savannah region. Future campaigns should include more purposeful social and health education on the importance and advantages of the use of treated nets to save lives in the Sahel Savannah region of Nigeria.</p

Are Self-Reported Fertility Preferences Biased? Evidence from Indirect Elicitation Methods

Desired fertility measures are routinely collected and used by researchers and policy makers, but their self-reported nature raises the possibility of reporting bias. In this paper we test for the presence of such bias by comparing responses to direct survey questions with indirect questions offering a varying, randomized, degree of confidentiality to respondents in a socioeconomically diverse sample of Nigerian women (N = 6,256). We find that women report higher fertility preferences when asked indirectly, but only when their responses afford them complete confidentiality, not when their responses are simply blind to the enumerator. Our results suggest that there may be fewer unintended pregnancies than currently thought, and that the effectiveness of family planning policy targeting may be weakened by the bias we uncover. We conclude with suggestions for future work on how to mitigate reporting bias