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Table 3 Validation results for maternal and newborn intrapartum and immediate postnatal care indicators

From: Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care

Indicator

Total N

True Preva (%)

Sensitivityb (95 % CI)

Specificityc (95 % CI)

Self-report survey estimate (%), Based on sensitivity and specificityd

AUC (95 % CI) (>0.60)

IFe (0.75 to 1.25)

Criteria Metf

Indicators of Health Service Contacts

 Main provider labor- doctor or medical resident

580

96.2

82.3 (78.8-85.3)

27.3 (10.7-50.2)

81.9

0.55 (0.51-0.59)

0.85

IF

 Main provider delivery– doctor or medical resident

563

91.1

90.1 (87.1-92.5)

14.0 (5.8-26.7)

89.7

0.52 (0.48-0.56)

0.98

IF

Indicators of Content of Care

 Takes urine sample

572

25.2

50.0 (0.63-0.71)

84.4 (80.6-87.7)

24.3

0.67 (0.63-0.71)

0.97

Both

 Injection or IVg medication received at some time during labor, before birth of baby (general)

571

76.0

70.1 (65.5-74.3)

56.9 (48.2-65.4)

63.6

0.63 (0.59-0.68)

0.84

Both

 Episiotomy performed

580

67.8

97.7 (95.7-98.9)

63.1 (55.8-70.0)

78.1

0.80 (0.77-0.84)

1.2

Both

 Blood products given

582

2.41

35.7 (12.8-64.9)

98.4 (97.0-99.3)

2.4

0.67 (0.63-0.71)

1.0

Both

 Receives injection or IVg medication for induction or augmentation of labor

476

76.1

59.1 (53.9-64.2)

79.8 (71.3-86.8)

49.8

0.69 (0.65-0.74)

0.65

AUC

 Augments labor with uterotonic

472

75.2

49.6 (44.3-54.9)

81.2 (72.9-87.8)

42.0

0.65 (0.61-0.70)

0.56

AUC

 Membranes ruptured (labor induction or augmentation)

356

57.0

38.4 (31.7-45.5)

88.2 (82.0-92.9)

27.0

0.63 (0.58-0.68)

0.47

AUC

 Breastfeeding initiated within first hour of birthi

449

34.7

81.4 (74.4-87.2)

44.1 (38.3-49.9)

64.8

0.63 (0.58-0.67)

1.9

AUC

 First post-delivery exam, provider checks for involution

556

81.7

84.6 (80.9-87.8)

21.6 (14.0-30.8)

83.5

0.53 (0.49-0.57)

1.0

IF

 Palpates uterus after delivery of placenta

580

82.4

79.5 (78.4-85.5)

19.6 (9.7-25.4)

79.7

0.50 (0.45-0.54)

0.97

IF

 Uterotonic received 1-3 min after birth

580

64.0

61.5 (56.3-66.4)

40.7 (33.9-47.7)

60.7

0.51 (0.47-0.55)

0.95

IF

 3 AMTSLh elements: prophylactic uterotonic + controlled cord traction + uterine massage following delivery of placenta

549

81.2

75.7 (71.5-79.6)

24.0 (16.0-33.6)

75.7

0.50 (0.46-0.54)

0.93

IF

 HIV status checked

569

69.8

54.9 (49.9-59.9)

47.7 (40.0-55.4)

54.1

0.51 (0.47-0.55)

0.78

IF

 Induces labor with uterotonic

559

11.6

27.7 (17.3-40.2)

89.1 (86.0-91.7)

12.9

0.58 (0.54-0.62)

1.1

IF

 Woman received pain relief medication

581

79.4

89.4 (86.2-92.0)

20.0 (13.3-28.3)

87.4

0.55 (0.51-0.59)

1.1

IF

 First post-delivery exam, provider ask/checks for bleeding

590

80.5

87.4 (84.0-90.2)

12.2 (6.8-19.6)

87.5

0.50 (0.46-0.54)

1.1

IF

 First post-delivery exam, provider examines perineum

586

75.1

90.2 (87.1-92.8)

10.3 (5.9-16.4)

90.1

0.50 (0.46-0.54)

1.2

IF

 First post-delivery exam, provider takes temperature

586

66.9

94.4 (91.6-96.4)

8.8 (5.2-13.7)

93.4

0.52 (0.47-0.56)

1.4

 

 Encourages/assists woman to ambulate during labor

580

22.2

7.8 (3.8-13.8)

91.6 (88.6-94.0)

8.3

0.50 (0.46-0.54)

0.37

 

 Woman asked for pain relief medication at some time

575

44.7

32.7 (27.0-38.8)

78.9 (74.0-83.3)

26.3

0.56 (0.52-0.60)

0.59

 

 Something other than breastmilk given to baby within first hour of birthi

438

21.7

71.6 (61.4-80.4)

46.1 (40.7-51.5)

57.8

0.59 (0.54-0.64)

2.7

 

 Uterotonic received 1-3 min after delivery of placenta

576

20.0

95.7 (90.1-98.6)

6.3 (4.3-8.9)

94.1

0.51 (0.47-0.55)

4.7

 

 Baby given to mother immediately after birthi

580

10.3

63.3 (49.9-75.4)

40.6 (36.3-44.9)

59.8

0.52 (0.48-0.56)

5.8

 

Maternal Complications

 Severe bleeding (hemorrhage)

593

8.1

50.0 (35.2-64.8)

95.2 (93.1-96.9)

8.4

0.73 (0.69-0.76)

1.0

Both

 High blood pressure/convulsions (eclampsia)

594

2.4

57.1 (28.9-82.3)

79.5 (76.0-82.7)

21.4

0.68 (0.64-0.72)

9.1

AUC

 Complication (yes to any)

595

13.6

60.5 (50.3-72.3)

65.4 (61.3-69.7)

38.2

0.64 (0.60-0.68)

2.8

AUC

 None

595

86.4

65.6 (61.3-69.7)

61.7 (50.3-72.3)

61.8

0.64 (0.60-0.68)

0.72

AUC

  1. Validation analysis based on matched data, excluding ‘Don’t Know’ and missing responses. Sensitivity and specificity analysis was not performed for indicators that had fewer than 5 counts per cell of constructed two-by-two tables
  2. aTrue prevalence refers to prevalence of intervention or event as measured by direct observation by a trained third party in the study hospital facility; bTrue positive rate; cTrue negative rate; dEstimated prevalence that would be obtained through women’s self-report in a household survey (Pr), calculated using the following equation where P = true prevalence, SE = sensitivity, SP = specificity, Pr = P*(SE + SP-1) + (1-SP); eIF = Pr/P, or ratio of survey-based prevalence to the true prevalence; fAUC > 0.60 and 0.75 < IF < 1.25; gIV refers to intravenous medication; hRefers to active management of the third stage of labor; iQuestions asked of mothers whose infants were breathing at birth
  3. *Note: For full description of study indicators, please see Additional file 5: Table S1