Quality of basic maternal care functions in low-income countries
Authors: Angeliki Antonakou, Dimitrios Papoutsis
Journal: The Lancet Global Health (2017)

Margaret Kruk and colleagues (November, 2016)1Kruk ME Leslie HH Verguet S Mbaruku G Adanu RMK Langer A Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys.Lancet Glob Health. 2016; 11: e845-e855Summary Full Text Full Text PDF Scopus (160) Google Scholar report on the quality of basic maternal care and the association with the volume of deliveries and surgical capacity in five sub-Saharan African countries. They conclude that, in low-income countries, facilities with caesarean section capacity and with birth volumes greater than 500 per year had higher scores for maternal care quality. We would like to invite Kruk and colleagues to provide any information they may have about whether the women attending the primary or secondary health facilities to give birth were at low risk or high risk of complications during delivery. It could be that women who would be considered to be at high risk gave birth in primary instead of secondary health facilities because of geographical restrictions, therefore skewing the score results of the process-of-care indicators the researchers used in their 12-item summative index of care quality. Likewise, women at low risk delivering at secondary health facilities would make the process-of-care indicators look better because of the occurrence of fewer complications, even after acknowledging the fact that 30% of women considered to be at low risk might develop an unexpected complication during or after delivery.2Danilack VA Nunes AP Phipps MG Unexpected complications of low-risk pregnancies in the United States.Am J Obstet Gynecol. 2015; 212 (809 e6): 809 e1Summary Full Text Full Text PDF PubMed Scopus (42) Google Scholar In England, and in accordance with NICE guidance,3NICE Guideline (cg190)Intrapartum care for healthy women and babies. National Institute for Health and Clinical Excellence, London2014Google Scholar women are offered continuous risk assessment throughout pregnancy, and if classified to be at low risk of complications at delivery they are advised that they can deliver safely at home or in freestanding midwifery-led settings. However, if a woman is considered to be at high risk then the planned place of birth is advised to be within the obstetric unit to ensure a safer perinatal outcome. We declare no competing interests. Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveysMore than 40% of facility deliveries in these five African countries occurred in primary care facilities, which scored poorly on basic measures of maternal care quality. Facilities with caesarean section capacity, particularly those with birth volumes higher than 500 per year, had higher scores for maternal care quality. Low-income and middle-income countries should systematically assess and improve the quality of delivery care in health facilities to accelerate reduction of maternal and newborn deaths. Full-Text PDF Open AccessQuality of basic maternal care functions in low-income countries – Authors' replyWe appreciate the comment from Angeliki Antonakou and Dimitrios Papoutsis on our Article1 on quality of maternal care in low-income countries. They expressed a concern that the quality index might result in artificially lower scores for primary care facilities if sicker women were using these more often than secondary care facilities. However, the opposite is true. Five of the seven process indicators in the 12-item index were indicators for the performance of a signal function (basic emergency obstetric procedure) in the past 3 months. Full-Text PDF Open Access