Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi

Background Health facility service environment is an important factor for newborns survival and well–being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. Methods We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Results Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19–1.95, P = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50–2.83, P < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. Conclusions There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of health staff in facilities that offer normal delivery and newborn care services at all levels in the country.

[1]  Malawi.  Malawi Demographic and Health Survey 2015-16 , 2017 .

[2]  H. Campbell,et al.  Linking household and facility data for better coverage measures in reproductive, maternal, newborn, and child health care: systematic review , 2016, Journal of global health.

[3]  Jamie Perin,et al.  Diarrhea management in children under five in sub-Saharan Africa: does the source of care matter? A Countdown analysis , 2016, BMC Public Health.

[4]  A. Barros,et al.  Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment , 2016, PloS one.

[5]  T. Colbourn,et al.  Malawi and Millennium Development Goal 4: a Countdown to 2015 country case study. , 2016, The Lancet. Global health.

[6]  F. Johnson.  A geospatial analysis of the impacts of maternity care fee payment policies on the uptake of skilled birth care in Ghana , 2016 .

[7]  Fiifi Amoako Johnson.  A geospatial analysis of the impacts of maternity care fee payment policies on the uptake of skilled birth care in Ghana , 2016, BMC Pregnancy and Childbirth.

[8]  A. Blanc,et al.  Assessing the validity of indicators of the quality of maternal and newborn health care in Kenya , 2016, Journal of global health.

[9]  M. Mathai,et al.  Count every newborn; a measurement improvement roadmap for coverage data , 2015, BMC Pregnancy and Childbirth.

[10]  Clara R Burgert-Brucker,et al.  Geographic variation in key indicators of maternal and child health across 27 countries in sub-Saharan Africa , 2015 .

[11]  D. Amongin,et al.  Use of early postnatal care among postpartum women in Eastern Uganda , 2015, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[12]  Jai K Das,et al.  Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? , 2014, The Lancet.

[13]  S. Adedini,et al.  Does it Really Matter Where Women Live? A Multilevel Analysis of the Determinants of Postnatal Care in Nigeria , 2014, Maternal and Child Health Journal.

[14]  J. Spencer,et al.  Geographically linking population and facility surveys: methodological considerations , 2013, Population Health Metrics.

[15]  C. Stanton,et al.  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 , 2013, PloS one.

[16]  A. Igwegbe,et al.  Barriers to postnatal care and exclusive breastfeeding among urbanwomen in southeastern Nigeria , 2013, Nigerian medical journal : journal of the Nigeria Medical Association.

[17]  S. Gabrysch,et al.  Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia , 2012, PloS one.

[18]  M. Mathai,et al.  New Signal Functions to Measure the Ability of Health Facilities to Provide Routine and Emergency Newborn Care , 2012, PLoS medicine.

[19]  J. Lawn,et al.  Newborn survival in Uganda: a decade of change and future implications. , 2012, Health policy and planning.

[20]  T. Colbourn,et al.  Newborn survival in Malawi: a decade of change and future implications. , 2012, Health policy and planning.

[21]  C. Mathers,et al.  Levels and trends in child mortality. Report 2012. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. , 2012 .

[22]  J. Cox,et al.  The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System , 2011, PLoS medicine.