SEARCHCROSS-SECTIONALpublic health, obstetrics and gynecology

cross-sectional·public health, obstetrics and gynecology, epidemiology, research methods·PMC10389737

Can women’s reports in client exit interviews be used to measure and track progress of antenatal care services quality? Evidence from a facility assessment census in Malawi

PLOS ONE · 7 authors, 4 centres

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TL;DR

This cross-sectional study compared women's self-reports in exit interviews with direct observation by trained healthcare professionals for six antenatal care indicators in Malawi. Concrete and observable interventions (malaria prophylaxis and iron/folic tablets) were reported accurately, while counselling-related indicators had lower reporting accuracy.

Full summary

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Using data from the 2013–2014 Malawi Service Provision Facility Census, this study compared women's reports in exit interviews with direct observation by trained healthcare professionals for six ANC indicators. Validity was assessed using AUC and inflation factor (IF), and reliability using Kappa and PABAK coefficients. Two concrete and observable indicators—whether the provider prescribed or gave malaria prophylaxis (AUC: 0.84; IF: 0.96) or iron/folic tablets (AUC: 0.84; IF: 1.00)—met validity criteria for both AUC ≥ 0.7 and 0.75 > IF > 1.25. Four counselling-related indicators (nutrition, delivery preparation, pregnancy complications, iron/folic acid side effects) had AUC values below 0.70 and did not meet validity criteria. Observable indicators demonstrated high reliability with Kappa and PABAK values in the ranges of ≥ 0.61 and ≥ 0.80. A limitation is that the study assessed immediate recall at facility discharge, which may not generalise to household surveys with longer recall periods.

STUDY TYPE

cross-sectional

SPECIALTY

public health

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10389737

Can women’s reports in client exit interviews be used to measure and track progress of antenatal care services quality? Evidence from a facility assessment census in Malawi

PLOS ONE

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ABSTRACT

Introduction Unlike household surveys, client exit interviews are conducted immediately after a consultation and therefore provides an opportunity to capture routine performance and level of service quality. This study examines the validity and reliability of women’s reports on selected ANC interventions in exit interviews conducted in Malawi. Methods Using data from the 2013–2014 Malawi service provision facility census, we compared women’s reports in exit interviews regarding the contents of ANC received with reports obtained through direct observation by a trained healthcare professional. The validity of six indicators was tested using two measures: the area under the receiver operating characteristic curve (AUC), and the inflation factor (IF). Reliability of women’s reports was measured using the Kappa coefficient (κ) and the prevalence-adjusted bias-adjusted kappa (PABAK). Finally, we examined whether reporting reliability varied significantly by individual and facility characteristics. Results Of the six indicators, two concrete and observable measures had high reporting accuracy and met the validity criteria for both AUC ≥ 0.7 and 0.75>IF>1.25, namely whether the provider prescribed or gave malaria prophylaxis (AUC: 0.84, 95% CI: 0.83–0.86; IF: 0.96) or iron/folic tablets (AUC: (0.84 95% CI: 0.81–0.87; IF:1.00). Whereas four measures related to counselling had lower reporting accuracy: whether the provider offered counselling about nutrition in pregnancy (AUC: 0.69, 95%CI: 0.67–0.71; IF = 1.26), delivery preparation (AUC: 0.62, 95% CI: 0.60–065; IF = 0.99), pregnancy related complications (AUC: 0.59, 95%CI: 0.56–0.61; IF = 1.11), and iron/folic acid side effects (AUC:0.58, 95% CI: 0.55–0.60; IF = 1.42). Similarly, the observable measures had high reliability with both κ and PABAK values in the ranges of ≥ 0.61 and ≥ 0.80. Respondent’s age, primiparous status, number of antenatal visits, and the type of health provider increased the likelihood of reporting reliability. Conclusion In order to enhance the measurement of quality of ANC services, our study emphasizes the importance of carefully considering the type of information women are asked to recall and the timing of the interviews. While household survey programmes such as the demographic health survey and multiple indicator cluster survey are commonly used as data sources for measuring intervention coverage and quality, policy makers should complement such data with more reliable sources like routine data from health information systems.

CITATION EXPORT

Martina Mchenga, Ronelle Burger, Dieter von Fintel et al.. Can women’s reports in client exit interviews be used to measure and track progress of antenatal care services quality? Evidence from a facility assessment census in Malawi. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0274650

AUTHORS

7 · 4 CENTRES

Martina Mchenga, Ronelle Burger, Dieter von Fintel, Miquel Vall-llosera Camps, Bereket Yakob, Bereket Yakob, Bereket Yakob

1 Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
2 Graduate School of Economic Sciences and Management, Stellenbosch University, Stellenbosch, Western Cape, South Africa
3 Economics Department, Stellenbosch University, Stellenbosch, South Africa
The Uniersity of British Columbia, ETHIOPIA

EDITOR / REVIEWER

Bereket Yakob