title: Adding content to contacts: measurement of high quality contacts for maternal and newborn health in Ethiopia, north east Nigeria, and Uttar Pradesh, India.
abstract: 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.
  
  
  RESULTS
  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.
authors.affiliation: Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Tanya
authors.initials: T
authors.lastname: Marchant
authors.affiliation: Health Hub Ltd., Abuja, Nigeria.
authors.forename: Ritgak Dimka
authors.initials: RD
authors.lastname: Tilley-Gyado
authors.affiliation: JaRco Consulting, Addis Ababa, Ethiopia.
authors.forename: Tsegahun
authors.initials: T
authors.lastname: Tessema
authors.affiliation: Sambodhi Research and Communications Pvt. Ltd, New Delhi, 110024, India.
authors.forename: Kultar
authors.initials: K
authors.lastname: Singh
authors.affiliation: Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Gautham
authors.affiliation: Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Nasir
authors.initials: N
authors.lastname: Umar
authors.affiliation: Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Della
authors.initials: D
authors.lastname: Berhanu
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.affiliation: Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Joanna R M
authors.initials: JR
authors.lastname: Armstrong Schellenberg
mesh_terms: D000328:Adult; D005002:Ethiopia; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D000068104:Infant Health; D007231:Infant, Newborn; D000068097:Maternal Health; D008427:Maternal Health Services; D009549:Nigeria; D011247:Pregnancy; D011295:Prenatal Care; D012424:Rural Population; D012959:Socioeconomic Factors