Stemming the tide: A study of technical and perceived quality of care and their associations with maternal health determinants Open Access
Swedo, Elizabeth (2012)
Abstract
Background: The impoverished West African nation of Mali has
one of the worst maternal mortality rates in the world - 830
maternal deaths per 100,000 live births. Many of these deaths have
been attributed to poor utilization of maternal health services.
Little research has been done to investigate how quality of care -
both technical and perceived - influences women's decision to seek
maternal care.
Objective: This study utilizes measures of both technical
and perceived quality of care and household data to analyze
associations between quality of care and maternal healthcare
uptake.
Methods: Study participants were women who had given birth
within the previous twelve months. Additionally, health facility
audits were conducted in all CS-COM facilities in Bandiagara and
Bankass, two regions of Mopti, Mali. Data from health facility
audits and the household survey were linked and analyzed using
bivariate analysis and logistic regression. Outcomes included
skilled delivery in a healthcare facility, receipt of four
antenatal care (ANC) visits, receipt of one ANC visit during the
first trimester, and receipt of the WHO minimum standard of
ANC.
Results: Bivariate analysis of household data revealed that
parity, education, cohabitation with one's mother-in-law, and
employment outside the home were significant factors for maternal
health service uptake. Among perceived quality of care domains,
maternal health service utilization was associated with perceived
physical accessibility, satisfaction with quality of service
offered at CS-COM, perceived equipment functionality, and safety of
delivery at CS-COM. Technical measurements of CS-COMs revealed
sub-optimal signal function capabilities, avoidable maternal and
neonatal deaths, absent or broken equipment, frequent medication
stockouts, and a paucity of retrained staff; however, only
equipment and medication stockouts were significantly associated
with maternal health service uptake.
Discussion: The results of this study suggest that women's
perceived quality of care at their local healthcare institution
influences their choice to utilize maternal health services.
Efforts to improve maternal health services must include provisions
for better technical quality of care and outreach to the community
to improve perceived quality of care.
Table of Contents
LITERATURE REVIEW 5
Characterizing maternal mortality worldwide 5
Maternal mortality in Mali 12
Determinants of maternal mortality 18
Global uptake of maternal health services 32
Determinants of maternal healthcare uptake in sub-Saharan Africa 45
Quality of care: a quest towards definition 55
Quality in maternity care 63
Distinguishing technical quality of care & patient satisfaction 70
Healthcare quality and its influence on uptake 77
Measuring quality in maternity care 80
The current state of research in maternal quality of care in sub-Saharan Africa 93
Improving maternal healthcare quality 107
Gaps in the literature 113
METHODS 119
RESULTS 140
DISCUSSION 158
Results: a closer look 158
The results in context 165
Limitations 167
Policy and program implications 168
Conclusion 170
REFERENCES 172
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