title: Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa.
abstract: BACKGROUND
  High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions.
  
  
  RESULTS
  Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries.
  
  
  CONCLUSIONS
  As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement.
authors.affiliation: Department of Population, Family Planning, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Vandana
authors.initials: V
authors.lastname: Tripathi
authors.affiliation: Department of Population, Family Planning, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Stanton
authors.affiliation: Department of Population, Family Planning, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Donna
authors.initials: D
authors.lastname: Strobino
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Linda
authors.initials: L
authors.lastname: Bartlett
mesh_terms: D017954:Africa South of the Sahara; D019540:Area Under Curve; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007391:International Cooperation; D007630:Kenya; D007743:Labor, Obstetric; D008270:Madagascar; D009774:Obstetrics / Q000592:standards; D018743:Perinatal Care / Q000458:organization & administration* / Q000592:standards*; D011247:Pregnancy; D011336:Probability; D016730:Program Development; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012372:ROC Curve; D013636:Tanzania