Kaji Korotki

Date of Award

Fall 2022

Document Type

Open Access Dissertation

Department

Public Health

First Advisor

M. Mahmud Khan

Abstract

INTRODUCTION: The quality of obstetric care is low in Bangladesh, especially at the sub-district level, and below sub-district level facilities such as union health centers and community clinics. Using nationally representative health facility assessment survey data, this study assessed the change in the quality of basic and comprehensive obstetric care in terms of human resources, equipment, and service availability at sub-district public health facilities in 2014 and 2017.

METHODS: Based on Donabedian’s model of quality of care (QoC), the quality of comprehensive delivery care was measured using an index of 9 indicators known as Signal Functions (SF), while basic obstetric care quality was assessed using 13 indicators of Service Availability and Readiness Assessment (SARA). The indicators were combined to define the QoC index, which varies from zero to 1.0, with 1.0 being the best possible outcome. The facility assessment survey reviewed the ability of the facility to perform signal functions in the previous three months from the date of the interview. The study ran multiple linear regression models to find the association between delivery rate and quality. The study also studied the factors associated with obstetric care quality.

RESULTS: The QoC index of comprehensive obstetric care was 0.67 in 2014 and 0.69 in 2017 in terms of the ability of the facilities to perform SF in the past 3 months of the survey. Only eight facilities in 2014 and 11 facilities in 2017 reported the ability to perform all nine SF. Regression analysis found a strong association between delivery rate and QoC index (p-value 0.009).

The average quality of basic obstetric care, SARA index score was 0.659 (SD, 0.266) in 2014 and 0.674 (SD, 0.204) in 2017 in terms of the ability of the facilities to perform SARA indicators in the past 3 months of the survey. Only 20 facilities in 2014 and five facilities in 2017 reported the ability to perform all 13 indicators (p-value=0.005). Regression analysis found a strong association of the service availability index with the practice of kangaroo mother care for low-weight babies (beta 0.192, p-value 0.019), 24- hour delivery personnel available in the facility (beta 0.180, p-value 0.027), and reviewing clients’ opinion (beta 0.163, p-value 0.000).

CONCLUSION: We found that the availability increased in several indicators: oxytocic, anticonvulsant, and blood transfusion. During this period, the availability of five SF, seven SF, and nine SF, delivery room supplies such as delivery kits, examination lights, newborn bags & masks, and skin disinfectants also increased. However, the mean QoC did not improve, and we found that it did not increase mainly due to one indicator that did not change: cesarean delivery. SF indicators often depend on trained human resources, supplies, and medicines. Cesarean delivery, an indicator of SF depends on the availability of anesthetist-gynecologist pairs at the facility. This study found that the availability of anesthetist-gynecologist pairs was reduced between the two survey periods. To the best of our knowledge, if this single factor could improve, QoC score would improve as well.

Based on the findings of the study, Bangladeshi policymakers should focus on keeping the anesthetist and gynecologist pair posted and available at the sub-district facilities and make sure that c-section delivery care is available all over the year. Government should also focus on the availability of medicines, supplies, and trained staff so that these facilities can provide instant EOC care to the community people.

Rights

© 2022, Kaji Korotki

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