Measures matter: A scoping review of maternal and newborn indicators

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Abstract

Background

A variety of global-level monitoring initiatives have recommended indicators for tracking progress in maternal and newborn health. As a first step supporting the work of WHO’s Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR) Technical Advisory Group, we aimed to compile and synthesize recommended indicators in order to document the landscape of maternal and newborn measurement and monitoring.

Methods

We conducted a scoping review of indicators proposed by global multi-stakeholder groups to suggest next steps to further support maternal and newborn measurement and monitoring.

Indicators pertaining to pregnancy, childbirth, and postpartum/postnatal and newborn care were extracted and included in the indicator compilation, together with key indicator metadata. We examined patterns and relationships across the compiled indicators.

Results

We identified 140 indicators linked to maternal and newborn health topics across the continuum of service provision. Fifty-five indicators relate to inputs and processes, 30 indicators relate to outputs, outcomes comprise 37 indicators in the database, and 18 impact indicators. A quarter of indicators proposed by global groups is either under development/discussion or is considered “aspirational”, highlighting the currently evolving monitoring landscape. Although considerable efforts have been made to harmonize indicator recommendations, there are still relatively few indicators shared across key monitoring initiatives and some of those that are shared may have definitional variation.

Conclusion

Rapid, wide-ranging work by a number of multi-stakeholder groups has resulted in a substantial number of indicators, many of which partially overlap and many are not supported with adequate documentation or guidance. The volume of indicators, coupled with the number of initiatives promoting different indicator lists, highlight the need for strengthened coordination and technical leadership to harmonize recommendations for improved measurement and monitoring of data related to maternal and newborn heath.

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Most cited references 11

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Measuring Coverage in MNCH: Testing the Validity of Women's Self-Report of Key Maternal and Newborn Health Interventions during the Peripartum Period in Mozambique

Cynthia Stanton, Barbara Rawlins, Mary Jane Drake … (2013)

Background As low-income countries strive to meet targets for Millennium Development Goals 4 and 5, there is growing need to track coverage and quality of high-impact peripartum interventions. At present, nationally representative household surveys conducted in low-income settings primarily measure contact with the health system, shedding little light on content or quality of care. The objective of this study is to validate the ability of women in Mozambique to report on facility-based care they and their newborns received during labor and one hour postpartum. Methods and Findings The study involved household interviews with women in Mozambique whose births were observed eight to ten months previously as part of a survey of the quality of maternal and newborn care at government health facilities. Of 487 women whose births were observed and who agreed to a follow-up interview, 304 were interviewed (62.4%). The validity of 34 indicators was tested using two measures: area under receiver operator characteristic curve (AUC) and inflation factor (IF); 27 indicators had sufficient numbers for robust analysis, of which four met acceptability criteria for both (AUC >0.6 and 0.75

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Adding Content to Contacts: Measurement of High Quality Contacts for Maternal and Newborn Health in Ethiopia, North East Nigeria, and Uttar Pradesh, India

Tanya Marchant, Ritgak Dimka Tilley-Gyado, Tsegahun Tessema … (2015)

Background Families in high mortality settings need regular contact with high quality services, but existing population-based measurements of contacts do not reflect quality. To address this, in 2012, we designed linked household and frontline worker surveys for Gombe State, Nigeria, Ethiopia, and Uttar Pradesh, India. Using reported frequency and content of contacts, we present a method for estimating the population level coverage of high quality contacts. Methods and Findings Linked cluster-based household and frontline health worker surveys were performed. Interviews were conducted in 40, 80 and 80 clusters in Gombe, Ethiopia, and Uttar Pradesh, respectively, including 348, 533, and 604 eligible women and 20, 76, and 55 skilled birth attendants. High quality contacts were defined as contacts during which recommended set of processes for routine health care were met. In Gombe, 61% (95% confidence interval 50-72) of women had at least one antenatal contact, 22% (14-29) delivered with a skilled birth attendant, 7% (4-9) had a post-partum check and 4% (2-8) of newborns had a post-natal check. Coverage of high quality contacts was reduced to 11% (6-16), 8% (5-11), 0%, and 0% respectively. In Ethiopia, 56% (49-63) had at least one antenatal contact, 15% (11-22) delivered with a skilled birth attendant, 3% (2-6) had a post-partum check and 4% (2-6) of newborns had a post-natal check. Coverage of high quality contacts was 4% (2-6), 4% (2-6), 0%, and 0%, respectively. In Uttar Pradesh 74% (69-79) had at least one antenatal contact, 76% (71-80) delivered with a skilled birth attendant, 54% (48-59) had a post-partum check and 19% (15-23) of newborns had a post-natal check. Coverage of high quality contacts was 6% (4-8), 4% (2-6), 0%, and 0% respectively. Conclusions Measuring content of care to reflect the quality of contacts can reveal missed opportunities to deliver best possible health care.

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Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya

Katharine McCarthy, Ann K. Blanc, Charlotte Warren … (2016)

Background Tracking progress on maternal and newborn survival requires accurate information on the coverage of essential interventions. Despite widespread use, most indicators measuring maternal and newborn intervention coverage have not been validated. This study assessed the ability of women delivering in two Kenyan hospitals to recall critical elements of care received during the intrapartum and immediate postnatal period at two time points: hospital discharge and 13–15 months following delivery. Methods Women’s reports of received care were compared against observations by trained third party observers. Indicators selected for validation were either currently in use or have the potential to be included in population–based surveys. We used a mixed–methods approach to validate women’s reporting ability. We calculated individual–reporting accuracy using the area under the receiver operating curve (AUC), population–level accuracy using the inflation factor (IF), and compared the accuracy of women’s reporting at baseline and follow–up. We also assessed the consistency of women’s reporting over time. We used in–depth interviews with a sub–set of women (n = 20) to assess their understanding of key survey terms. Results Of 606 women who participated at baseline and agreed to follow–up, 515 were re–interviewed. Thirty–eight indicators had sufficient sample size for validation analysis; ten met criteria for high or moderate reporting accuracy (0.60

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Author and article information

Contributors

Ann-Beth Moller:

ORCID: http://orcid.org/0000-0003-3581-0938

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: ResourcesRole: Writing – review & editing

Holly Newby: Role: Data curationRole: Formal analysisRole: Writing – original draft

Claudia Hanson: Role: Writing – review & editing

Alison Morgan:

ORCID: http://orcid.org/0000-0001-5380-1619

Role: Writing – review & editing

Shams El Arifeen: Role: Writing – review & editing

Doris Chou: Role: Writing – review & editing

Theresa Diaz: Role: Writing – review & editing

Lale Say: Role: Writing – review & editing

Ian Askew: Role: Writing – review & editing

Allisyn C. Moran: Role: ConceptualizationRole: Formal analysisRole: ResourcesRole: Writing – review & editing

Abraham Salinas-Miranda: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 9 October 2018

Publication date Collection: 2018

Volume: 13

Issue: 10

Electronic Location Identifier: e0204763

Affiliations

[1 ] UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

[2 ] Independent Consultant, Stockholm, Sweden

[3 ] Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

[4 ] Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia

[5 ] Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

[6 ] Department of Maternal, Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland

University of South Florida, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: mollera@ 123456who.int

Author information

Ann-Beth Moller http://orcid.org/0000-0003-3581-0938

Alison Morgan http://orcid.org/0000-0001-5380-1619

Article

Publisher ID: PONE-D-18-15212

DOI: 10.1371/journal.pone.0204763

PMC ID: 6177145

PubMed ID: 30300361

SO-VID: c2b24114-b77c-485f-9c97-cc4c59e8c3db

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 5 June 2018

Date accepted : 13 September 2018

Page count

Figures: 2, Tables: 3, Pages: 19

Funding

Funded by: the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization

Award Recipient :

ORCID: http://orcid.org/0000-0003-3581-0938

Ann-Beth Moller

Funded by: Bill and Melinda Gates Foundation (US)

Award Recipient :

ORCID: http://orcid.org/0000-0003-3581-0938

Ann-Beth Moller

This work received support from the Bill & Melinda Gates Foundation, and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization (WHO).

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Measures matter: A scoping review of maternal and newborn indicators

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Most cited references 11

Measuring Coverage in MNCH: Testing the Validity of Women's Self-Report of Key Maternal and Newborn Health Interventions during the Peripartum Period in Mozambique

Adding Content to Contacts: Measurement of High Quality Contacts for Maternal and Newborn Health in Ethiopia, North East Nigeria, and Uttar Pradesh, India

Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya

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