Measuring skilled attendance at birth using linked household, health facility, and health worker surveys in Ethiopia, North-East Nigeria, and Uttar Pradesh, India

Abstract

Background: The measurement of key intervention coverage to improve maternal health is complex. Large scale household surveys provide high-quality estimates of the number of women who have skilled attendance at birth, but most provide little or no detail about the quality of care women receive. For example, information on the preparedness of the skilled birth attendant to manage labour is not included. Here we describe measurement of key intervention coverage for mothers using linked household data, health facility and health worker data. Methods: In 2012, linked household, health facility and health worker survey data were collected to ascertain the relationship between women having interactions with health workers, and the population level coverage of key interventions for mothers and newborns. Data from each source was linked at the level of the household cluster: sub-villages. All women living in the sub-village were interviewed with a special module for women who had a birth in the previous 12 months. The health facility providing services to these women was surveyed to determine preparedness to provide care, and frontline health workers in the village were interviewed. The number and quality of interactions taking place, and the extent to which this translated into coverage of key interventions, was explored. Findings: Health facility, health worker and household data were all needed to estimate the six intra-partum interventions that usually fall under the proxy indicator ‘skilled attendance at birth’. Data is presented to illustrate measurement complexities, and the gap between coverage of skilled birth attendance, quality of care, and the coverage of the six key intra-partum interventions. Interpretation: Measurement across the continuum of care requires linking multiple data collection approaches. Developing methods to unpack key interventions for mothers, and for their newborns, is of critical importance to develop strategies for improved survival